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Deep Brain Stimulation of the Pallidum Internum for Gilles de la Tourette Syndrome: A Patient-Specific Model-Based Simulation Study of the Electric Field
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology. (MINT)ORCID iD: 0000-0002-0012-7867
Unit of Functional Neurosurgery, Institute of Neurology, University College London, London, UK.
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, The Institute of Technology.
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2015 (English)In: Neuromodulation (Malden, Mass.), ISSN 1094-7159, E-ISSN 1525-1403, no 2, 90-96 p.Article in journal (Refereed) Published
Abstract [en]

Objectives

The aim of this study was to investigate the deep brain stimulation (DBS) electric field distribution in proton-density MRI scans visualizing the globus pallidus internus (GPi) of patients with Gilles de la Tourette syndrome (GTS), along with its relation to the anatomy.

Methods

Patient-specific brain tissue models (n = 7) with bilateral DBS electrodes in the GPi were set up using the finite element method in five patients who had undergone stereotactic proton-density MRI-guided surgery and showed variable improvement with DBS. Simulations (n = 27) of the electric field were performed and the results visualized on the respective preoperative stereotactic MRI scans. The mean electric field volumes (n = 81) within the 0.1, 0.15, and 0.2 V/mm isosurfaces were calculated and compared with the anatomy.

Results

Visualization of the simulated electric field confirmed that the anteromedial limbic GPi was the main stimulated target for four of the patients and the posteromedial sensorimotor GPi for one. Larger volumes extended asymmetrically, with parts of fields stretching into the lamina between GPi and globus pallidus externus and into the internal capsule. There was a high correlation (r = 0.994, n = 54) between volumes and brain sides, but with a systematic shift toward the right side, especially for the larger volumes. Simulations with homogeneous tissue models showed no differences.

Conclusions

Patient-specific DBS electric field simulations in the GPi as visualized on proton-density MR scans can be implemented in patients with GTS. Visualization of electric fields together with stereotactic thin-slice MRI can provide further support when predicting anatomical structures possibly influenced by DBS in this complex disorder.

Place, publisher, year, edition, pages
John Wiley & Sons, 2015. no 2, 90-96 p.
Keyword [en]
Deep brain stimulation, electric field simulation, globus pallidus internus, modeling and simulation, Tourette syndrome
National Category
Medical Biotechnology Medical Bioscience
Identifiers
URN: urn:nbn:se:liu:diva-113589DOI: 10.1111/ner.12248ISI: 000350461600004PubMedID: 25284508OAI: oai:DiVA.org:liu-113589DiVA: diva2:783069
Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2017-12-05Bibliographically approved

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Wårdell, KarinDiczfalusy, ElinAndersson, MatsÅström, Mattias

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Wårdell, KarinDiczfalusy, ElinAndersson, MatsÅström, Mattias
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Department of Biomedical EngineeringThe Institute of TechnologyBiomedical InstrumentationCenter for Medical Image Science and Visualization (CMIV)
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Neuromodulation (Malden, Mass.)
Medical BiotechnologyMedical Bioscience

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