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Probabilistic mapping of deep brain stimulation effects in essential tremor
Department of Neurology, University of Cologne, Cologne, Germany; Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.
Department of Neurology, University of Cologne, Cologne, Germany.
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering. Medtronic Neuromodulation, Medtronic Eindhoven Design Center, Eindhoven, The Netherlands. (MINT)
Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.
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2017 (English)In: NeuroImage: Clinical, ISSN 0353-8842, E-ISSN 2213-1582, Vol. 13Article in journal (Refereed) Published
Abstract [en]

Objective

To create probabilistic stimulation maps (PSMs) of deep brain stimulation (DBS) effects on tremor suppression and stimulation-induced side-effects in patients with essential tremor (ET).

Method

Monopolar reviews from 16 ET-patients which consisted of over 600 stimulation settings were used to create PSMs. A spherical model of the volume of neural activation was used to estimate the spatial extent of DBS for each setting. All data was pooled and voxel-wise statistical analysis as well as nonparametric permutation testing was used to confirm the validity of the PSMs.

Results

PSMs showed tremor suppression to be more pronounced by stimulation in the zona incerta (ZI) than in the ventral intermediate nucleus (VIM). Paresthesias and dizziness were most commonly associated with stimulation in the ZI and surrounding thalamic nuclei.

Discussion

Our results support the assumption, that the ZI might be a very effective target for tremor suppression. However stimulation inside the ZI and in its close vicinity was also related to the occurrence of stimulation-induced side-effects, so it remains unclear whether the VIM or the ZI is the overall better target. The study demonstrates the use of PSMs for target selection and evaluation. While their accuracy has to be carefully discussed, they can improve the understanding of DBS effects and can be of use for other DBS targets in the therapy of neurological or psychiatric disorders as well. Furthermore they provide a priori information about expected DBS effects in a certain region and might be helpful to clinicians in programming DBS devices in the future.

Abbreviations: DBS, Deep brain stimulation; ET, Essential tremor; PSA, Posterior subthalamic area; PSM, Probabilistic stimulation map; VIM, Ventral intermediate nucleus; VNA, Volume of neural activation; ZI, Zona incerta

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 13
Keyword [en]
Deep brain stimulation, Essential tremor, Probabilistic mapping, Zona incerta
National Category
Medical Engineering
Identifiers
URN: urn:nbn:se:liu:diva-133819DOI: 10.1016/j.nicl.2016.11.019ISI: 000401413700020OAI: oai:DiVA.org:liu-133819DiVA: diva2:1063718
Note

Funding agencies: European Union; German Research Foundation [KFO-219]; Medtronic (ODIS trial); Medtronic (EARLYSTIM trial); Boston Scientific (VANTAGE and REGISTRY trial); St. Jude Medical and Sapiens steering brain stimulation

Available from: 2017-01-10 Created: 2017-01-10 Last updated: 2017-06-13

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CiteExportLink to record
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