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Published on: August 12, 2018
Toward Individualized Deep Brain Stimulation: A Stereoelectroencephalography-Based Workflow for Neurostimulation
Jeremy Saal1, Kelly Kadlec2, Anusha B Allawala1
1UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
This study introduces a statistics-driven framework using stereoelectroencephalography (sEEG) to find personalized deep brain stimulation (DBS) targets for neuropsychiatric disorders. The method ensures statistically rigorous identification of effective stimulation sites.
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 treatment approaches.
- Identifying optimal stimulation sites is crucial for effective DBS therapy.
Purpose of the Study:
- To develop and present a statistics-driven framework for stimulation testing using inpatient stereoelectroencephalography (sEEG).
- To identify personalized therapeutic stimulation sites for subsequent DBS implantation.
- To enhance the rigor and efficiency of stimulation site selection.
Main Methods:
- Inpatient sEEG testing and symptom monitoring in 14 participants (MDD, chronic pain, OCD).
- Integration of a Stimulation Testing Decision Tree with power analysis and effect size calculations.
- Utilizing sham trials to estimate response variability and inform power analysis.
Main Results:
- Effect sizes for stimulation-induced symptom changes ranged from -1.5 to +2.39.
- Sham trial response standard deviation predicted stimulation response variability (R² = 0.67, p < 0.001).
- Approximately ten sham trials are needed to estimate variability; ten trials per site ensure powered results for effect sizes ≥1.1.
Conclusions:
- The presented workflow is adaptable across multiple neuropsychiatric indications.
- The framework addresses challenges in stimulation site testing.
- Incorporating sham trials, effect size, and tolerability testing identifies personalized and effective DBS sites.
