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Programming of subthalamic nucleus deep brain stimulation with hyperdirect pathway and corticospinal tract-guided
Alba Segura-Amil1,2, Andreas Nowacki1, Ines Debove3
1Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
Human Brain Mapping
|June 15, 2023
Summary
This study developed models to optimize deep brain stimulation (DBS) for Parkinson's disease by targeting the hyperdirect pathway (HDP) for benefits and avoiding the corticospinal tract (CST) for side effects.
Area of Science:
- Neuroscience
- Neurosurgery
- Biomedical Engineering
Background:
- Deep brain stimulation (DBS) of the subthalamic nucleus (STN) effectively treats advanced Parkinson's disease.
- Beneficial effects are linked to hyperdirect pathway (HDP) stimulation, while capsular side effects stem from corticospinal tract (CST) activation.
Purpose of the Study:
- To develop and validate patient-specific models for suggesting optimal STN DBS stimulation parameters.
- To guide DBS programming by estimating thresholds for HDP activation (therapeutic effect) and CST activation (side effects).
Main Methods:
- Retrospective analysis of 20 Parkinson's disease patients with bilateral STN DBS.
- Patient-specific probabilistic tractography to identify HDP and CST.
- Estimation of activated tissue volumes and pathway streamlines based on monopolar review stimulation parameters.
Main Results:
- Models indicated 50% HDP activation at effect threshold and 4% CST activation at side effect threshold.
- Suggested stimulation parameters significantly outperformed random suggestions in cross-validation.
- Median suggestion errors were 1 mA for effect threshold and 1.5 mA for side effect threshold.
Conclusions:
- Developed models successfully suggested STN DBS settings based on HDP and CST activation.
- Tract-guided DBS programming holds promise for optimizing Parkinson's disease treatment.
- Prospective studies are needed to refine and implement these tract-guided programming strategies.
