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Published on: August 12, 2018
Probabilistic stimulation mapping from intra-operative thalamic deep brain stimulation data in essential tremor
Dorian Vogel1, Teresa Nordin2, Stefanie Feiler3
1Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, Muttenz, Switzerland.
This study introduces a new method to analyze deep brain stimulation (DBS) data from essential tremor (ET) patients. The analysis generated probabilistic stimulation maps (PSMs) that identified effective stimulation areas, aiding surgical planning and understanding DBS mechanisms.
Area of Science:
- Neurosurgery and Neurological Disorders
- Biomedical Engineering
- Computational Neuroscience
Background:
- Deep brain stimulation (DBS) is a crucial therapy for Parkinson's disease (PD) and essential tremor (ET), yet its precise mechanism of action remains incompletely understood.
- Retrospective group analysis of intra-operative data from ET patients undergoing DBS in the ventral intermediate nucleus of the thalamus (Vim) is rare.
- Intra-operative stimulation tests offer rich data, but their group analysis has not been extensively explored.
Purpose of the Study:
- To implement, evaluate, and apply a novel group analysis workflow for generating probabilistic stimulation maps (PSMs).
- To utilize intra-operative stimulation test data from ET patients implanted in the Vim.
- To enhance the understanding of DBS mechanisms and assist in surgical planning for ET.
Main Methods:
- Constructed a group-specific anatomical template using MRI scans from 6 ET and 13 PD patients.
- Analyzed intra-operative test data (n=1821) from 6 ET patients, including electric field simulations and tremor assessments via acceleration sensors.
- Generated occurrence and weighted mean maps, identified voxels with symptomatic response using a linear mixed model to form a PSM, and compared PSM predictions with clinical assessments.
Main Results:
- The generated PSM identified effective stimulation regions in the posterior sub-thalamic area (PSA) and at the border of the Vim and ventro-oral nucleus (VO).
- Comparison with existing literature showed a center-to-center distance < 5 mm and a Dice overlap score of 0.4 for significant clusters.
- The workflow successfully identified effective stimulation areas, affirming current medical literature on DBS for ET.
Conclusions:
- The developed workflow and analysis of intra-operative stimulation test data effectively identified key stimulation areas for tremor improvement in ET patients.
- Probabilistic analysis of intra-operative data holds significant potential for elucidating DBS mechanisms of action.
- This approach can serve as a valuable tool to assist and refine surgical planning for DBS procedures.
