Deep brain stimulation (DBS) is an established therapy for the treatment of Parkinson's disease (PD) and shows great promise for the treatment of several other disorders. However, while the clinical analysis of DBS has received great attention, a relative paucity of quantitative techniques exists to define the optimal surgical target and most effective stimulation protocol for a given disorder. In this study we describe a methodology that represents an evolutionary addition to the concept of a probabilistic brain atlas, which we call a probabilistic stimulation atlas (PSA). We outline steps to combine quantitative clinical outcome measures with advanced computational models of DBS to identify regions where stimulation-induced activation could provide the best therapeutic improvement on a per-symptom basis. While this methodology is relevant to any form of DBS, we present example results from subthalamic nucleus (STN) DBS for PD. We constructed patient-specific computer models of the volume of tissue activated (VTA) for 163 different stimulation parameter settings which were tested in six patients. We then assigned clinical outcome scores to each VTA and compiled all of the VTAs into a PSA to identify stimulation-induced activation targets that maximized therapeutic response with minimal side effects. The results suggest that selection of both electrode placement and clinical stimulation parameter settings could be tailored to the patient's primary symptoms using patient-specific models and PSAs.
Bibliographical noteFunding Information:
This work was supported by grants from the National Institutes of Health (grant numbers: R21 NS050449 , F32 NS052042 , R01 NS059736 ). BioPSE software was made possible in part by a grant from the NIH/NCRR Center for Integrative Biomedical Computing, P41-RR12553-10. The authors would like to thank Susumu Mori for providing the diffusion tensor brain atlas and Kevin Wang for assistance with analysis of the clinical data.
- Computational model
- Parkinson's disease
- Subthalamic nucleus