Towards individualized deep brain stimulation: A stereoelectroencephalography-based workflow for neurostimulation...

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Deep brain stimulation (DBS) is a growing treatment for neuropsychiatric conditions.
• Individual symptom presentations and neural correlates necessitate personalized therapeutic approaches.
• Current methods for identifying DBS targets can be challenging due to individual variability.

Purpose of the Study:

• To develop and validate a statistics-driven framework for unbiased stimulation testing.
• To identify personalized therapeutic stimulation sites for chronic DBS implantation using inpatient stereoelectroencephalography (sEEG).
• To enhance the precision and efficacy of DBS targeting for diverse neuropsychiatric disorders.

Main Methods:

• Utilized inpatient stereoelectroencephalography (sEEG) in 14 participants (MDD, chronic pain, OCD).
• Integrated a Stimulation Testing Decision Tree with power analysis and effect size calculations.
• Incorporated sham trials to estimate response variability and ensure statistically rigorous results.

Main Results:

• Effect sizes for stimulation-induced symptom changes ranged from -1.59 to +2.59.
• Sham trial variability strongly correlated with stimulation response variability (r = 0.86, p < 0.001).
• 12-15 sham trials are recommended for robust variability estimation; 10 trials per site are sufficient for effect sizes ≥ 1.1.

Conclusions:

• The presented workflow is adaptable across indications for stimulation site testing.
• The framework overcomes challenges in identifying personalized, unbiased, and clinically efficacious DBS targets.
• Incorporating sham trials, effect size, and tolerability testing optimizes DBS target identification.