Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Christopher R. Butson, Scott E. Cooper, Jaimie M. Henderson, Cameron C. McIntyre

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393 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)661-670
Number of pages10
JournalNeuroImage
Volume34
Issue number2
DOIs
StatePublished - Jan 15 2007

Bibliographical note

Funding Information:
This work was supported by grants from the American Parkinson Disease Association, the Ohio Biomedical Research and Technology Transfer Partnership, and the National Institutes of Health (NS-50449 and NS-52042). The authors would also like to thank Susumu Mori for providing the diffusion tensor image brain atlas, Christopher Maks and Ashu Chaturvedi for assistance with the model simulations, and Barbara Wolgamuth for assistance with the clinical data collection. Conflict of Interest Statement: CRB, JMH, and CCM hold intellectual property related to this project and company shares in IntElect Medical Inc.

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