Patient-speciftic analysis of the volume of tissue activated during deep brain stimulation
Patient-speciftic analysis of the volume of tissue activated during deep brain stimulation
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DOI：
10.1016/j.neuroimage.2006.09.034
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发表时间：
2007-01-15
期刊：
影响因子：
5.7
通讯作者：
McIntyre, Cameron C.
中科院分区：
文献类型：
--
作者：
Butson, Christopher R.;Cooper, Scott E.;McIntyre, Cameron C.
尽管脑深部电刺激（DBS）在治疗运动障碍方面取得了临床成功，但其对神经系统的影响仍存在许多问题。本研究提出了一种方法来预测DBS在患者特定基础上激活的组织体积（VTA）。我们的目标是识别腹侧被盖区与周围解剖结构之间的交叉点，并将这些结构的激活与临床结果进行比较。该模型系统由三个基本组成部分组成：（1）大脑中皮质下核和DBS电极位置的3D解剖模型，每个都来自磁共振成像（MRI）;（2）DBS电极和传输到大脑的电场的有限元模型，具有来自扩散张量MRI的组织电导率特性;（3）从有髓鞘轴突对所施加电场的响应导出的VTA预测，其是刺激参数（接触、阻抗、电压、脉冲宽度、频率）的函数。我们使用这个模型系统来分析丘脑底核（DBS）DBS治疗帕金森病患者的效果。在一系列刺激参数设置下评价了运动迟缓、僵硬和皮质脊髓束（CST）运动阈值的定量测量。我们的模型预测与CST阈值表现出良好的一致性。此外，通过改善运动迟缓和僵硬的电极触点刺激产生的VTA与Forel（ZI/H2）的VTA/场重叠。DBS技术在各种神经系统疾病中的应用先于直接受刺激影响的组织体积的科学表征。临床分析、神经影像学、神经解剖学和神经刺激建模的协同整合为解决与DBS的治疗受益和副作用相关的因素的广泛问题提供了机会。(c)2006年爱思唯尔公司All rights reserved.
Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. This study presents a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals were to identify the intersection between the VTA and surrounding anatomical structures and to compare activation of these structures with clinical outcomes. The model system consisted of three fundamental components: (1) a 3D anatomical model of the subcortical nuclei and DBS electrode position in the brain, each derived from magnetic resonance imaging (MRI); (2) a finite element model of the DBS electrode and electric field transmitted to the brain, with tissue conductivity properties derived from diffusion tensor MRI; (3) VTA prediction derived from the response of myelinated axons to the applied electric field, which is a function of the stimulation parameters (contact, impedance, voltage, pulse width, frequency). We used this model system to analyze the effects of subthalamic nucleus (STN) DBS in a patient with Parkinson's disease. Quantitative measurements of bradykinesia, rigidity, and corticospinal tract (CST) motor thresholds were evaluated over a range of stimulation parameter settings. Our model predictions showed good agreement with CST thresholds. Additionally, stimulation through electrode contacts that improved bradykinesia and rigidity generated VTAs that overlapped the zona incerta/fields of Forel (ZI/H2). Application of DBS technology to various neurological disorders has preceded scientific characterization of the volume of tissue directly affected by the stimulation. Synergistic integration of clinical analysis, neuroimaging, neuroanatomy, and neurostimulation modeling provides an opportunity to address wide ranging questions on the factors linked with the therapeutic benefits and side effects of DBS. (c) 2006 Elsevier Inc. All rights reserved.