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Conti A, Gambadauro NM, Mantovani P, Picciano CP, Rosetti V, Magnani M, Lucerna S, Tuleasca C, Cortelli P, Giannini G. A Brief History of Stereotactic Atlases: Their Evolution and Importance in Stereotactic Neurosurgery. Brain Sci 2023; 13:brainsci13050830. [PMID: 37239302 DOI: 10.3390/brainsci13050830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/05/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Following the recent acquisition of unprecedented anatomical details through state-of-the-art neuroimaging, stereotactic procedures such as microelectrode recording (MER) or deep brain stimulation (DBS) can now rely on direct and accurately individualized topographic targeting. Nevertheless, both modern brain atlases derived from appropriate histological techniques involving post-mortem studies of human brain tissue and the methods based on neuroimaging and functional information represent a valuable tool to avoid targeting errors due to imaging artifacts or insufficient anatomical details. Hence, they have thus far been considered a reference guide for functional neurosurgical procedures by neuroscientists and neurosurgeons. In fact, brain atlases, ranging from the ones based on histology and histochemistry to the probabilistic ones grounded on data derived from large clinical databases, are the result of a long and inspiring journey made possible thanks to genial intuitions of great minds in the field of neurosurgery and to the technical advancement of neuroimaging and computational science. The aim of this text is to review the principal characteristics highlighting the milestones of their evolution.
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Affiliation(s)
- Alfredo Conti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Nicola Maria Gambadauro
- Stroke Unit- Barking, Havering and Redbrige University Hospitals NHS Trust, Queen's Hospital, Rom Valley Way, London RM7 0AG, UK
| | - Paolo Mantovani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Canio Pietro Picciano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Vittoria Rosetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Marcello Magnani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Sebastiano Lucerna
- Department of Neurosurgery, AOU "G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Rue du Bugnon 21 CH-1011, 1015 Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Rte Cantonale, 1015 Lausanne, Switzerland
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Giulia Giannini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
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Hamdan AC, Vieira MD. Stroop Test for Parkinson's Disease with Deep Brain Stimulation: A Systematic Review. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:29-34. [PMID: 36591546 PMCID: PMC9776780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Deep brain stimulation (DBS) is considered an alternative treatment for patients with rapidly developing Parkinson's disease (PD). DBS can cause cognitive changes, and it is necessary to perform an executive assessment before and after DBS to better define the prognosis. Objective The aim of this study was to analyze the use of the Stroop test for assessment of cognitive functions in patients with PD undergoing DBS. Methods The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, Scopus, PsycInfo, and Web of Science were used as electronic databases. All included studies assessed the cognitive ability of patients with PD undergoing DBS through the application of the Stroop test. Results Thirty-five articles met the inclusion criteria. Among the studies, there were different formats of Stroop applications. Twenty-three articles presented negative results in relation to the individuals' performances in Stroop, compared to the control groups. The results suggested that there was no correlation between low performance in the test and global cognitive risk for the patients. Conclusion Patients with DBS declined in Stroop performance and showed impairments in response inhibition and speed. These results are not related to the lack of cognitive security of DBS. The Stroop test can be combined with other cognitive instruments to ensure greater approximation of results with reality measures.
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Affiliation(s)
- Amer Cavalheiro Hamdan
- Dr. Hamdan is with the Graduate Program in Psychology, Department of Psychology, Federal University of Parana in Curitiba, Brazil
| | - Mariana Drabik Vieira
- Dr. Vieira is a psychologist, candidate to master's in psychology, Department of Psychology, Graduate Program in Psychology, Federal University of Parana in Curitiba, Brazil
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Lachenmayer ML, Mürset M, Antih N, Debove I, Muellner J, Bompart M, Schlaeppi JA, Nowacki A, You H, Michelis JP, Dransart A, Pollo C, Deuschl G, Krack P. Subthalamic and pallidal deep brain stimulation for Parkinson's disease-meta-analysis of outcomes. NPJ PARKINSONS DISEASE 2021; 7:77. [PMID: 34489472 PMCID: PMC8421387 DOI: 10.1038/s41531-021-00223-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 08/12/2021] [Indexed: 12/26/2022]
Abstract
Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) and the subthalamic nucleus (STN) has become an established treatment for Parkinson’s disease (PD), a recent meta-analysis of outcomes is lacking. To address this gap, we performed a meta-analysis of bilateral STN- and GPi-DBS studies published from 1990-08/2019. Studies with ≥10 subjects reporting Unified Parkinson’s Disease Rating Scale (UPDRS) III motor scores at baseline and 6–12 months follow-up were included. Several outcome variables were analyzed and adverse events (AE) were summarized. 39 STN studies (2035 subjects) and 5 GPi studies (292 subjects) were eligible. UPDRS-II score after surgery in the stimulation-ON/medication-OFF state compared to preoperative medication-OFF state improved by 47% with STN-DBS and 18.5% with GPi-DBS. UPDRS-III score improved by 50.5% with STN-DBS and 29.8% with GPi-DBS. STN-DBS improved dyskinesia by 64%, daily OFF time by 69.1%, and quality of life measured by PDQ-39 by 22.2%, while Levodopa Equivalent Daily Dose (LEDD) was reduced by 50.0%. For GPi-DBS information regarding dyskinesia, OFF time, PDQ-39 and LEDD was insufficient for further analysis. Correlation analysis showed that preoperative L-dopa responsiveness was highly predictive of the STN-DBS motor outcome across all studies. Most common surgery-related AE were infection (5.1%) and intracranial hemorrhage (3.1%). Despite a series of technological advances, outcomes of modern surgery are still comparable with those of the early days of DBS. Recent changes in target selection with a preference of GPi in elderly patients with cognitive deficits and more psychiatric comorbidities require more published data for validation.
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Affiliation(s)
- M Lenard Lachenmayer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Melina Mürset
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ines Debove
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia Muellner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Janine-Ai Schlaeppi
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hana You
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joan P Michelis
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Claudio Pollo
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guenther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Paul Krack
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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de Roquemaurel A, Wirth T, Vijiaratnam N, Ferreira F, Zrinzo L, Akram H, Foltynie T, Limousin P. Stimulation Sweet Spot in Subthalamic Deep Brain Stimulation - Myth or Reality? A Critical Review of Literature. Stereotact Funct Neurosurg 2021; 99:425-442. [PMID: 34120117 DOI: 10.1159/000516098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION While deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been extensively used for more than 20 years in Parkinson's disease (PD), the optimal area of stimulation to relieve motor symptoms remains elusive. OBJECTIVE We aimed at localizing the sweet spot within the subthalamic region by performing a systematic review of the literature. METHOD PubMed database was searched for published studies exploring optimal stimulation location for STN DBS in PD, published between 2000 and 2019. A standardized assessment procedure based on methodological features was applied to select high-quality publications. Studies conducted more than 3 months after the DBS procedure, employing lateralized scores and/or stimulation condition, and reporting the volume of tissue activated or the position of the stimulating contact within the subthalamic region were considered in the final analysis. RESULTS Out of 439 references, 24 were finally retained, including 21 studies based on contact location and 3 studies based on volume of tissue activated (VTA). Most studies (all VTA-based studies and 13 of the 21 contact-based studies) suggest the superior-lateral STN and the adjacent white matter as the optimal sites for stimulation. Remaining contact-based studies were either inconclusive (5/21), favoured the caudal zona incerta (1/21), or suggested a better outcome of STN stimulation than adjacent white matter stimulation (2/21). CONCLUSION Using a standardized methodological approach, our review supports the presence of a sweet spot located within the supero-lateral STN and extending to the adjacent white matter.
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Affiliation(s)
- Alexis de Roquemaurel
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Thomas Wirth
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Neurology department, Strasbourg University Hospital, Strasbourg, France.,INSERM-U964/CNRS-UMR7104/University of Strasbourg, Illkirch-Graffenstaden, France
| | - Nirosen Vijiaratnam
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Francisca Ferreira
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Harith Akram
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Abstract
Human brain atlases have been evolving tremendously, propelled recently by brain big projects, and driven by sophisticated imaging techniques, advanced brain mapping methods, vast data, analytical strategies, and powerful computing. We overview here this evolution in four categories: content, applications, functionality, and availability, in contrast to other works limited mostly to content. Four atlas generations are distinguished: early cortical maps, print stereotactic atlases, early digital atlases, and advanced brain atlas platforms, and 5 avenues in electronic atlases spanning the last two generations. Content-wise, new electronic atlases are categorized into eight groups considering their scope, parcellation, modality, plurality, scale, ethnicity, abnormality, and a mixture of them. Atlas content developments in these groups are heading in 23 various directions. Application-wise, we overview atlases in neuroeducation, research, and clinics, including stereotactic and functional neurosurgery, neuroradiology, neurology, and stroke. Functionality-wise, tools and functionalities are addressed for atlas creation, navigation, individualization, enabling operations, and application-specific. Availability is discussed in media and platforms, ranging from mobile solutions to leading-edge supercomputers, with three accessibility levels. The major application-wise shift has been from research to clinical practice, particularly in stereotactic and functional neurosurgery, although clinical applications are still lagging behind the atlas content progress. Atlas functionality also has been relatively neglected until recently, as the management of brain data explosion requires powerful tools. We suggest that the future human brain atlas-related research and development activities shall be founded on and benefit from a standard framework containing the core virtual brain model cum the brain atlas platform general architecture.
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Affiliation(s)
- Wieslaw L Nowinski
- John Paul II Center for Virtual Anatomy and Surgical Simulation, University of Cardinal Stefan Wyszynski, Woycickiego 1/3, Block 12, room 1220, 01-938, Warsaw, Poland.
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Malaga KA, Costello JT, Chou KL, Patil PG. Atlas-independent, N-of-1 tissue activation modeling to map optimal regions of subthalamic deep brain stimulation for Parkinson disease. NEUROIMAGE-CLINICAL 2020; 29:102518. [PMID: 33333464 PMCID: PMC7736726 DOI: 10.1016/j.nicl.2020.102518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/13/2023]
Abstract
Neuroanatomical variations among patients are obscured in atlas-based VTA modeling. N-of-1 neuroanatomical and VTA modeling enables patient-level precision. Mean optimal stimulation is dorsomedial to the STN, near its posterior half. Individual VTAs deviate from optimal stimulation sites to varying degrees. Optimal stimulation sites for rigidity, bradykinesia, and tremor partially overlap.
Background Motor outcomes after subthalamic deep brain stimulation (STN DBS) for Parkinson disease (PD) vary considerably among patients and strongly depend on stimulation location. The objective of this retrospective study was to map the regions of optimal STN DBS for PD using an atlas-independent, fully individualized (N-of-1) tissue activation modeling approach and to assess the relationship between patient-level therapeutic volumes of tissue activation (VTAs) and motor improvement. Methods The stimulation-induced electric field for 40 PD patients treated with bilateral STN DBS was modeled using finite element analysis. Neurostimulation models were generated for each patient, incorporating their individual STN anatomy, DBS lead position and orientation, anisotropic tissue conductivity, and clinical stimulation settings. A voxel-based analysis of the VTAs was then used to map the optimal location of stimulation. The amount of stimulation in specific regions relative to the STN was measured and compared between STNs with more and less optimal stimulation, as determined by their motor improvement scores and VTA. The relationship between VTA location and motor outcome was then assessed using correlation analysis. Patient variability in terms of STN anatomy, active contact position, and VTA location were also evaluated. Results from the N-of-1 model were compared to those from a simplified VTA model. Results Tissue activation modeling mapped the optimal location of stimulation to regions medial, posterior, and dorsal to the STN centroid. These regions extended beyond the STN boundary towards the caudal zona incerta (cZI). The location of the VTA and active contact position differed significantly between STNs with more and less optimal stimulation in the dorsal-ventral and anterior-posterior directions. Therapeutic stimulation spread noticeably more in the dorsal and posterior directions, providing additional evidence for cZI as an important DBS target. There were significant linear relationships between the amount of dorsal and posterior stimulation, as measured by the VTA, and motor improvement. These relationships were more robust than those between active contact position and motor improvement. There was high variability in STN anatomy, active contact position, and VTA location among patients. Spherical VTA modeling was unable to reproduce these results and tended to overestimate the size of the VTA. Conclusion Accurate characterization of the spread of stimulation is needed to optimize STN DBS for PD. High variability in neuroanatomy, stimulation location, and motor improvement among patients highlights the need for individualized modeling techniques. The atlas-independent, N-of-1 tissue activation modeling approach presented in this study can be used to develop and evaluate stimulation strategies to improve clinical outcomes on an individual basis.
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Affiliation(s)
- Karlo A Malaga
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Joseph T Costello
- Department of Electrical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
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Palard-Novello X, Drapier S, Bonnet A, Girard A, Robert G, Houvenaghel JF, Sauleau P, Vérin M, Haegelen C, Le Jeune F. Deep brain stimulation of the internal globus pallidus does not affect the limbic circuit in patients with Parkinson's disease: a PET study. J Neurol 2020; 268:701-706. [PMID: 32914208 DOI: 10.1007/s00415-020-10212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Internal globus pallidus (GPi) deep brain stimulation (DBS) is a safe and effective alternative treatment in Parkinson's disease (PD) for patients with cognitive impairment. However, no study has yet investigated metabolic changes within a large series of patients undergoing GPi stimulation. OBJECTIVE We assessed motor, cognitive and psychiatric changes, as well as modifications in brain glucose metabolism measured with FDG-PET, before and after bilateral GPi-DBS. METHODS In the same week, 32 patients with PD underwent a motor, cognitive and psychiatric assessment and a resting-state FDG-PET scan, 4 months before and 4 months after GPi-DBS surgery. For the voxelwise metabolic change assessment, the p value was controlled for multiple comparisons using the family wise error rate. RESULTS After GPi-DBS surgery, patients showed a significant overall improvement in motor status. No cognitive or psychiatric changes were observed after surgery. Nor were any clusters with significantly relative metabolic changes found in the limbic circuit after surgery. Clusters with significantly relative metabolic changes were observed in the left and right Brodmann area (BA) 6, the right BA 9, the right and left BA 39 and the left BA 17. CONCLUSION The present study confirmed that GPi-DBS is an effective treatment in patients with advanced PD, owing to metabolic changes in the areas involved in motor execution. The absence of relative metabolic decrease in the limbic circuit and the few changes affecting the associative circuit could explain why GPi-DBS is cognitively safe.
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Affiliation(s)
- Xavier Palard-Novello
- Department of Nuclear Medicine, Eugene Marquis Center, University of Rennes 1, Avenue de la bataille Flandres-Dunkerque, 35000, Rennes, France. .,UMR 1099 LTSI, INSERM, University of Rennes, Rennes, France.
| | - Sophie Drapier
- Department of Neurology, University Hospital of Rennes, Rennes, France.,"Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
| | - Alexandre Bonnet
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - Antoine Girard
- Department of Nuclear Medicine, Eugene Marquis Center, University of Rennes 1, Avenue de la bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Gabriel Robert
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Department of Psychiatry, University Hospital of Rennes, Rennes, France
| | - Jean-François Houvenaghel
- Department of Neurology, University Hospital of Rennes, Rennes, France.,"Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
| | - Paul Sauleau
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Department of Neurophysiology, Rennes University Hospital, Rennes, France
| | - Marc Vérin
- Department of Neurology, University Hospital of Rennes, Rennes, France.,"Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
| | - Claire Haegelen
- UMR 1099 LTSI, INSERM, University of Rennes, Rennes, France.,Department of Neurosurgery, University Hospital of Rennes, Rennes, France
| | - Florence Le Jeune
- Department of Nuclear Medicine, Eugene Marquis Center, University of Rennes 1, Avenue de la bataille Flandres-Dunkerque, 35000, Rennes, France.,"Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
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Correction: Functional atlases for analysis of motor and neuropsychological outcomes after medial globus pallidus and subthalamic stimulation. PLoS One 2019; 14:e0223693. [PMID: 31581219 PMCID: PMC6776291 DOI: 10.1371/journal.pone.0223693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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