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Patient-Specific Model-Based Investigation of Speech Intelligibility and Movement during Deep Brain Stimulation
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology. (MINT)
University College, London. (Medical Faculty)
University Hospital, Umeå . (Medical Faculty)
University College, London.
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2010 (English)In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 88, no 4, 224-233 p.Article in journal (Refereed) Published
Abstract [en]

Background/Aims: Deep brain stimulation (DBS) is widely used to treat motor symptoms in patients with advanced Parkinson’s disease. The aim of this study was to investigate the anatomical aspects of the electric field in relation to effects on speech and movement during DBS in the subthalamic nucleus. Methods: Patient-specific finite element models of DBS were developed for simulation of the electric field in 10 patients. In each patient, speech intelligibility and movement were assessed during 2 electrical settings, i.e. 4 V (high) and 2 V (low). The electric field was simulated for each electrical setting. Results: Movement was improved in all patients for both high and low electrical settings. In general, high-amplitude stimulation was more consistent in improving the motor scores than low-amplitude stimulation. In 6 cases, speech intelligibility was impaired during high-amplitude electrical settings. Stimulation of part of the fasciculus cerebellothalamicus from electrodes positioned medial and/or posterior to the center of the subthalamic nucleus was recognized as a possible cause of the stimulation-induced dysarthria. Conclusion: Special attention to stimulation-induced speech impairments should be taken in cases when active electrodes are positioned medial and/or posterior to the center of the subthalamic nucleus.

Place, publisher, year, edition, pages
2010. Vol. 88, no 4, 224-233 p.
Keyword [en]
Deep brain stimulation, Dysarthria, Speech intelligibility, Parkinson’s disease, Electric field, Fasciculus cerebellothalamicus
National Category
Biomedical Laboratory Science/Technology
Identifiers
URN: urn:nbn:se:liu:diva-58057DOI: 10.1159/000314357ISI: 000280136100004OAI: oai:DiVA.org:liu-58057DiVA: diva2:331840
Note

Original Publication: Mattias Åström, Elina Tripoliti, Mawan I. Hariz, Ludvig U. Zrinzo, Irene Martinez-Torres, Patricia Limousin and Karin Wårdell, Patient-Specific Model-Based Investigation of Speech Intelligibility and Movement during Deep Brain Stimulation, 2010, Stereotactic and Functional Neurosurgery, (88), 4, 224-233. http://dx.doi.org/10.1159/000314357 Copyright: S. Karger AG http://www.karger.com/

Available from: 2010-07-27 Created: 2010-07-27 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Modelling, Simulaltion, and Visualization of Deep Brain Stimulation
Open this publication in new window or tab >>Modelling, Simulaltion, and Visualization of Deep Brain Stimulation
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Deep brain stimulation (DBS) is an effective surgical treatment for neurological diseases such as essential tremor, Parkinsonʹs disease (PD) and dystonia. DBS has so far been used in more than 70 000 patients with movement disorders, and is currently in trial for intractable Gilles de la Tourette’s syndrome, obsessive compulsive disorders, depression, and epilepsy. DBS electrodes are implanted with stereotactic neurosurgical techniques in the deep regions of the brain. Chronic electrical stimulation is delivered to the electrodes from battery-operated pulse generators that are implanted below the clavicle.

The clinical benefit of DBS is largely dependent on the spatial distribution of the electric field in relation to brain anatomy. To maximize therapeutic benefits while avoiding unwanted side-effects, knowledge of the distribution of the electric field in relation anatomy is essential. Due to difficulties in measuring electric fields in vivo, computerized analysis with finite element models have emerged as an alternative.

The aim of the thesis was to investigate technical and clinical aspects of DBS by means of finite element models, simulations, and visualizations of the electric field and tissue anatomy. More specifically the effects of dilated perivascular spaces filled with cerebrospinal fluid on the electrical field generated by DBS was evaluated. A method for patient-specific finite element modelling and simulation of DBS was developed and used to investigate the anatomical distribution of the electric field in relation to clinical effects and side effects. Patient-specific models were later used to investigate the electric field in relation to effects on speech and movement during DBS in patients with PD (n=10). Patient-specific models and simulations were also used to evaluate the influence of heterogeneous isotropic and heterogeneous anisotropic tissue on the electric field during DBS. In addition, methods were developed for visualization of atlas-based and patient-specific anatomy in 3D for interpretation of anatomy, visualization of neural activation with the activating function, and visualization of tissue micro structure. 3D visualization of anatomy was used to assess electrode contact locations in relation to stimulation-induced side-effects (n=331) during DBS for patients with essential tremor (n=28). The modelling, simulation, and visualization of DBS provided detailed information about the distribution of the electric field and its connection to clinical effects and side-effects of stimulation. In conclusion, the results of this thesis provided insights that may help to improve DBS as a treatment for movement disorders as well as for other neurological diseases in the future.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 84 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1384
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70090 (URN)978-91-7393-114-4 (ISBN)
Public defence
2011-09-09, Eken, Campus US, Linköpings universitet, Linköping, 09:00 (English)
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Supervisors
Available from: 2011-08-18 Created: 2011-08-18 Last updated: 2017-02-09Bibliographically approved

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