Pathway targeted deep brain stimulation for Parkinson's disease

帕金森病的靶向深部脑刺激途径

• 批准号: 8613159
• 负责人: NOAM HAREL
• 金额: $ 63.75万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8613159
• 关键词: Action Potentials; Adverse effects; Algorithms; Anatomic Models; Atlases; Axon; Basic Science; Behavior; Brain region; Clinical; Clinical Research; Clinical assessments; Cognitive; Computer Simulation; Coupled; Data; Deep Brain Stimulation; Diffusion weighted imaging; Electrodes; Elements; Equilibrium; Evaluation; Evolution; Generations; Globus Pallidus; Goals; Image; Imagery; Imaging Techniques; Implant; Investigation; Lead; Link; Location; Magnetic Resonance Imaging; Maps; Mediating; Modeling; Moods; Motor; Neural Pathways; Neurons; Neuropsychological Tests; Operative Surgical Procedures; Outcome; Outcome Measure; Output; Parkinson Disease; Pathway interactions; Patients; Predisposition; Probability; Process; Quality of life; Relative (related person); Research Subjects; Resolution; Rodent; Scheme; Stimulus; Structure of subthalamic nucleus; Symptoms; System; Technology; Therapeutic; clinical effect; clinical practice; cohort; effective therapy; electric field; image registration; implantation; improved; neuroimaging; prospective; public health relevance; research clinical testing; tool

PROJECT SUMMARY Subthalamic deep brain stimulation (DBS) is an effective for the treatment of Parkinson's disease (PD). However, little is known about the specific neural pathway(s) responsible for therapeutic benefit. Direct stimulation of either the hyperdirect pathway and/or the subthalamopallidal pathway represents two of the most likely candidates as the "target". Therefore, the goal of this project is to combine patient-specific 7T imaging and neurostimulation models together to enable probabilistic identification of the stimulation pathways linked to changes in clinical outcome measures recorded from subthalamic DBS patients. This study will rely on tractography-activation models (TAMs) to guide clinical testing on a cohort of 30 subthalamic DBS patients. Our multi-disciplinary approach will integrate the latest advances in neuroimaging, neurostimulation modeling, and quantitative clinical outcome measures to customize DBS to these patients. The first aim will acquire high- resolution 7T MRI data prior to their implant surgery. These images will provide unparalleled anatomical characterization of each patient. The second aim will create patient-specific TAMs for each subject. These models will enable us to define theoretically optimal settings for focused activation of either the hyperdirect pathway or the subthalamopallidal pathway. The third aim will quantify the clinical outcomes achieved with stimulation parameters defined by either the TAM or traditional clinical practice. These clinical results will be coupled with the TAM predictions to create a probabilistic tractography-activation atlas (PTAA) for the subthalamic region. The results of this study will help identify optimal implantation locations for DBS electrodes, and enable theoretical prediction of stimulation parameter settings that focus activation on the targeted pathways and/or avoid side-effect pathways.

项目摘要 丘脑底脑深部电刺激术（DBS）是治疗帕金森病（PD）的有效方法。 然而，对负责治疗益处的特定神经通路知之甚少。直接 刺激超直接通路和/或丘脑下通路代表了两种最重要的通路 候选人作为“目标”。因此，本项目的目标是将联合收割机与患者特异性7 T成像 和神经刺激模型结合在一起，以便能够概率性地识别与 丘脑底DBS患者记录的临床结局指标的变化。这项研究将依赖于 纤维束描记激活模型（TAM），以指导对30例丘脑下DBS患者的临床试验。 我们的多学科方法将整合神经成像，神经刺激建模， 和定量临床结果测量，以针对这些患者定制DBS。第一个目标是获得高- 分辨率7 T MRI数据。这些图像将提供无与伦比的解剖 每个病人的特征。第二个目标是为每个受试者创建患者特定的TAM。这些 模型将使我们能够定义理论上的最佳设置，用于集中激活超直接 途径或丘脑下途径。第三个目标将量化临床结果， 由TAM或传统临床实践定义的刺激参数。这些临床结果将 再加上TAM预测，以创建一个概率追踪激活图谱（PTAA）， 丘脑底区本研究的结果将有助于确定DBS的最佳植入位置 电极，并且使得能够理论预测刺激参数设置，所述刺激参数设置将激活集中在电极上。 靶向途径和/或避免副作用途径。