1
|
Wang D, Lu Y, Han Y, Zhang X, Dong S, Zhang H, Wang G, Wang G, Wang JJ. The Influence of Etiology and Stimulation Target on the Outcome of Deep Brain Stimulation for Chronic Neuropathic Pain: A Systematic Review and Meta-Analysis. Neuromodulation 2024; 27:83-94. [PMID: 36697341 DOI: 10.1016/j.neurom.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/12/2022] [Accepted: 12/01/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) to treat chronic neuropathic pain has shown variable outcomes. Variations in pain etiologies and DBS targets are considered the main contributing factors, which are, however, underexplored owing to a paucity of patient data in individual studies. An updated meta-analysis to quantitatively assess the influence of these factors on the outcome of DBS for chronic neuropathic pain is warranted, especially considering that the anterior cingulate cortex (ACC) has emerged recently as a new DBS target. MATERIALS AND METHODS A comprehensive literature review was performed in PubMed, Embase, and Cochrane data bases to identify studies reporting quantitative outcomes of DBS for chronic neuropathic pain. Pain and quality of life (QoL) outcomes, grouped by etiology and DBS target, were extracted and analyzed (α = 0.05). RESULTS Twenty-five studies were included for analysis. Patients with peripheral neuropathic pain (PNP) had a significantly greater initial stimulation success rate than did patients with central neuropathic pain (CNP). Both patients with CNP and patients with PNP with definitive implant, regardless of targets, gained significant follow-up pain reduction. Patients with PNP had greater long-term pain relief than did patients with CNP. Patients with CNP with ACC DBS gained less long-term pain relief than did those with conventional targets. Significant short-term QoL improvement was reported in selected patients with CNP after ACC DBS. However, selective reporting bias was expected, and the improvement decreased in the long term. CONCLUSIONS Although DBS to treat chronic neuropathic pain is generally effective, patients with PNP are the preferred population over patients with CNP. Current data suggest that ACC DBS deserves further investigation as a potential way to treat the affective component of chronic neuropathic pain.
Collapse
Affiliation(s)
- Dengyu Wang
- School of Medicine, Tsinghua University, Beijing, China; Institute for Precision Medicine, Tsinghua University, Beijing, China
| | - Yang Lu
- Institute for Precision Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yan Han
- School of Medicine, Tsinghua University, Beijing, China; Institute for Precision Medicine, Tsinghua University, Beijing, China
| | - Xiaolei Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Sheng Dong
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guoqin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Jin Wang
- Institute for Precision Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| |
Collapse
|
2
|
Motzkin JC, Kanungo I, D’Esposito M, Shirvalkar P. Network targets for therapeutic brain stimulation: towards personalized therapy for pain. Front Pain Res (Lausanne) 2023; 4:1156108. [PMID: 37363755 PMCID: PMC10286871 DOI: 10.3389/fpain.2023.1156108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Precision neuromodulation of central brain circuits is a promising emerging therapeutic modality for a variety of neuropsychiatric disorders. Reliably identifying in whom, where, and in what context to provide brain stimulation for optimal pain relief are fundamental challenges limiting the widespread implementation of central neuromodulation treatments for chronic pain. Current approaches to brain stimulation target empirically derived regions of interest to the disorder or targets with strong connections to these regions. However, complex, multidimensional experiences like chronic pain are more closely linked to patterns of coordinated activity across distributed large-scale functional networks. Recent advances in precision network neuroscience indicate that these networks are highly variable in their neuroanatomical organization across individuals. Here we review accumulating evidence that variable central representations of pain will likely pose a major barrier to implementation of population-derived analgesic brain stimulation targets. We propose network-level estimates as a more valid, robust, and reliable way to stratify personalized candidate regions. Finally, we review key background, methods, and implications for developing network topology-informed brain stimulation targets for chronic pain.
Collapse
Affiliation(s)
- Julian C. Motzkin
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
| | - Ishan Kanungo
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Prasad Shirvalkar
- Departments of Neurology and Anesthesia and Perioperative Care (Pain Management), University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
3
|
DePaoli D, Côté DC, Bouma BE, Villiger M. Endoscopic imaging of white matter fiber tracts using polarization-sensitive optical coherence tomography. Neuroimage 2022; 264:119755. [PMID: 36400379 PMCID: PMC9802682 DOI: 10.1016/j.neuroimage.2022.119755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Polarization sensitive optical coherence tomography (PSOCT) has been shown to image and delineate white matter fibers in a label-free manner by revealing optical birefringence within the myelin sheath using a microscope setup. In this proof-of-concept study, we adapt recent advancements in endoscopic PSOCT to perform depth-resolved imaging of white matter structures deep inside intact porcine brain tissue ex-vivo, through a small, rotational fiber probe. The probe geometry is comparable to microelectrodes currently used in neurosurgical interventions. The presented imaging system is mobile, robust, and uses biologically safe levels of optical radiation making it well suited for clinical translation. In neurosurgery, where accuracy is imperative, endoscopic PSOCT through a narrow-gauge fiber probe could provide intra-operative feedback on the location of critical white matter structures.
Collapse
Affiliation(s)
- Damon DePaoli
- Harvard Medical School, Boston, MA 02115, USA,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniel C. Côté
- CERVO Brain Research Center, Université Laval, Quebec City, Quebec G1E 1T2, Canada
| | - Brett E. Bouma
- Harvard Medical School, Boston, MA 02115, USA,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Martin Villiger
- Harvard Medical School, Boston, MA 02115, USA,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA,Corresponding author. (M. Villiger)
| |
Collapse
|
4
|
Grier MD, Yacoub E, Adriany G, Lagore RL, Harel N, Zhang RY, Lenglet C, Uğurbil K, Zimmermann J, Heilbronner SR. Ultra-high field (10.5T) diffusion-weighted MRI of the macaque brain. Neuroimage 2022; 255:119200. [PMID: 35427769 PMCID: PMC9446284 DOI: 10.1016/j.neuroimage.2022.119200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/08/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Diffu0sion-weighted magnetic resonance imaging (dMRI) is a non-invasive imaging technique that provides information about the barriers to the diffusion of water molecules in tissue. In the brain, this information can be used in several important ways, including to examine tissue abnormalities associated with brain disorders and to infer anatomical connectivity and the organization of white matter bundles through the use of tractography algorithms. However, dMRI also presents certain challenges. For example, historically, the biological validation of tractography models has shown only moderate correlations with anatomical connectivity as determined through invasive tract-tracing studies. Some of the factors contributing to such issues are low spatial resolution, low signal-to-noise ratios, and long scan times required for high-quality data, along with modeling challenges like complex fiber crossing patterns. Leveraging the capabilities provided by an ultra-high field scanner combined with denoising, we have acquired whole-brain, 0.58 mm isotropic resolution dMRI with a 2D-single shot echo planar imaging sequence on a 10.5 Tesla scanner in anesthetized macaques. These data produced high-quality tractograms and maps of scalar diffusion metrics in white matter. This work demonstrates the feasibility and motivation for in-vivo dMRI studies seeking to benefit from ultra-high fields.
Collapse
Affiliation(s)
- Mark D Grier
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, United States
| | - Essa Yacoub
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States; Center for Neuroengineering, University of Minnesota, Minneapolis, MN 55455, United States
| | - Gregor Adriany
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States; Center for Neuroengineering, University of Minnesota, Minneapolis, MN 55455, United States
| | - Russell L Lagore
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Noam Harel
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States; Department of Neurosurgery, University of Minnesota, Minneapolis, MN 55455, United States
| | - Ru-Yuan Zhang
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200030, P.R. China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, P.R. China; Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Kâmil Uğurbil
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States; Center for Neuroengineering, University of Minnesota, Minneapolis, MN 55455, United States
| | - Jan Zimmermann
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, United States; Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN 55455, United States; Center for Neuroengineering, University of Minnesota, Minneapolis, MN 55455, United States; Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, United States
| | - Sarah R Heilbronner
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, United States; Center for Neuroengineering, University of Minnesota, Minneapolis, MN 55455, United States.
| |
Collapse
|
5
|
Zhang Y, Furst AJ. Brainstem Diffusion Tensor Tractography and Clinical Applications in Pain. Front Pain Res (Lausanne) 2022; 3:840328. [PMID: 35399154 PMCID: PMC8989264 DOI: 10.3389/fpain.2022.840328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
The brainstem is one of the most vulnerable brain structures in many neurological conditions, such as pain, sleep problems, autonomic dysfunctions, and neurodegenerative disorders. Diffusion tensor imaging and tractography provide structural details and quantitative measures of brainstem fiber pathways. Until recently, diffusion tensor tractographic studies have mainly focused on whole-brain MRI acquisition. Due to the brainstem's spatial localization, size, and tissue characteristics, and limits of imaging techniques, brainstem diffusion MRI poses particular challenges in tractography. We provide a brief overview on recent advances in diffusion tensor tractography in revealing human pathways connecting the brainstem to the subcortical regions (e.g., basal ganglia, mesolimbic, basal forebrain), and cortical regions. Each of these pathways contains different distributions of fiber tracts from known neurotransmitter-specific nuclei in the brainstem. We compare the brainstem tractographic approaches in literature and our in-lab developed automated brainstem tractography in terms of atlas building, technical advantages, and neuroanatomical implications on neurotransmitter systems. Lastly, we summarize recent investigations of using brainstem tractography as a promising tool in association with pain.
Collapse
Affiliation(s)
- Yu Zhang
- War Related Illness and Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States,*Correspondence: Yu Zhang ;
| | - Ansgar J. Furst
- War Related Illness and Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, United States,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, United States,Polytrauma System of Care (PSC), VA Palo Alto Health Care System, Palo Alto, CA, United States
| |
Collapse
|
6
|
Hollunder B, Rajamani N, Siddiqi SH, Finke C, Kühn AA, Mayberg HS, Fox MD, Neudorfer C, Horn A. Toward personalized medicine in connectomic deep brain stimulation. Prog Neurobiol 2021;:102211. [PMID: 34958874 DOI: 10.1016/j.pneurobio.2021.102211] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
At the group-level, deep brain stimulation leads to significant therapeutic benefit in a multitude of neurological and neuropsychiatric disorders. At the single-patient level, however, symptoms may sometimes persist despite "optimal" electrode placement at established treatment coordinates. This may be partly explained by limitations of disease-centric strategies that are unable to account for heterogeneous phenotypes and comorbidities observed in clinical practice. Instead, tailoring electrode placement and programming to individual patients' symptom profiles may increase the fraction of top-responding patients. Here, we propose a three-step, circuit-based framework with the aim of developing patient-specific treatment targets that address the unique symptom constellation prevalent in each patient. First, we describe how a symptom network target library could be established by mapping beneficial or undesirable DBS effects to distinct circuits based on (retrospective) group-level data. Second, we suggest ways of matching the resulting symptom networks to circuits defined in the individual patient (template matching). Third, we introduce network blending as a strategy to calculate optimal stimulation targets and parameters by selecting and weighting a set of symptom-specific networks based on the symptom profile and subjective priorities of the individual patient. We integrate the approach with published literature and conclude by discussing limitations and future challenges.
Collapse
|
7
|
Wu C, Ferreira F, Fox M, Harel N, Hattangadi-Gluth J, Horn A, Jbabdi S, Kahan J, Oswal A, Sheth SA, Tie Y, Vakharia V, Zrinzo L, Akram H. Clinical applications of magnetic resonance imaging based functional and structural connectivity. Neuroimage 2021; 244:118649. [PMID: 34648960 DOI: 10.1016/j.neuroimage.2021.118649] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 12/23/2022] Open
Abstract
Advances in computational neuroimaging techniques have expanded the armamentarium of imaging tools available for clinical applications in clinical neuroscience. Non-invasive, in vivo brain MRI structural and functional network mapping has been used to identify therapeutic targets, define eloquent brain regions to preserve, and gain insight into pathological processes and treatments as well as prognostic biomarkers. These tools have the real potential to inform patient-specific treatment strategies. Nevertheless, a realistic appraisal of clinical utility is needed that balances the growing excitement and interest in the field with important limitations associated with these techniques. Quality of the raw data, minutiae of the processing methodology, and the statistical models applied can all impact on the results and their interpretation. A lack of standardization in data acquisition and processing has also resulted in issues with reproducibility. This limitation has had a direct impact on the reliability of these tools and ultimately, confidence in their clinical use. Advances in MRI technology and computational power as well as automation and standardization of processing methods, including machine learning approaches, may help address some of these issues and make these tools more reliable in clinical use. In this review, we will highlight the current clinical uses of MRI connectomics in the diagnosis and treatment of neurological disorders; balancing emerging applications and technologies with limitations of connectivity analytic approaches to present an encompassing and appropriate perspective.
Collapse
Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Third Floor, Philadelphia, PA 19107, USA; Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor, Philadelphia, PA 19107, USA.
| | - Francisca Ferreira
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Michael Fox
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota, 2021 Sixth Street S.E., Minneapolis, MN 55455, USA.
| | - Jona Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, Center for Precision Radiation Medicine, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Andreas Horn
- Neurology Department, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
| | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Joshua Kahan
- Department of Neurology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Ashwini Oswal
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Mansfield Rd, Oxford OX1 3TH, UK.
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge, Ninth Floor, Houston, TX 77030, USA.
| | - Yanmei Tie
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Vejay Vakharia
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK.
| | - Ludvic Zrinzo
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Harith Akram
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| |
Collapse
|
8
|
Coenen VA, Reisert M. DTI for brain targeting: Diffusion weighted imaging fiber tractography-Assisted deep brain stimulation. Int Rev Neurobiol 2021; 159:47-67. [PMID: 34446250 DOI: 10.1016/bs.irn.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fiber tractography assisted Deep Brain Stimulation (DBS) has been performed by different groups for more than 10 years to now. Groups around the world have adapted initial approaches to currently embrace the fiber tractography technology mainly for treating tremor (DBS and lesions), psychiatric indications (OCD and major depression) and pain (DBS). Despite the advantages of directly visualizing the target structure, the technology is demanding and is vulnerable to inaccuracies especially since it is performed on individual level. In this contribution, we will focus on tremor and psychiatric indications, and will show future applications of sophisticated tractography applications for subthalamic nucleus (STN) DBS surgery and stimulation steering as an example.
Collapse
Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany; Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany.
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany; Department of Radiology-Medical Physics, Freiburg University, Freiburg, Germany
| |
Collapse
|
9
|
Bergeron D, Obaid S, Fournier-Gosselin MP, Bouthillier A, Nguyen DK. Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework. Brain Sci 2021; 11:brainsci11050639. [PMID: 34063367 PMCID: PMC8156413 DOI: 10.3390/brainsci11050639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication. METHODS We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain. RESULTS Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds. CONCLUSION In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.
Collapse
Affiliation(s)
- David Bergeron
- Service de Neurochirurgie, Université de Montréal, Montréal, QC H3T 1L5, Canada; (S.O.); (M.-P.F.-G.); (A.B.)
- Correspondence:
| | - Sami Obaid
- Service de Neurochirurgie, Université de Montréal, Montréal, QC H3T 1L5, Canada; (S.O.); (M.-P.F.-G.); (A.B.)
| | | | - Alain Bouthillier
- Service de Neurochirurgie, Université de Montréal, Montréal, QC H3T 1L5, Canada; (S.O.); (M.-P.F.-G.); (A.B.)
| | - Dang Khoa Nguyen
- Service de Neurologie, Université de Montréal, Montréal, QC H3T 1L5, Canada;
| |
Collapse
|
10
|
Azriel A, Farrand S, Di Biase M, Zalesky A, Lui E, Desmond P, Evans A, Awad M, Moscovici S, Velakoulis D, Bittar RG. Tractography-Guided Deep Brain Stimulation of the Anteromedial Globus Pallidus Internus for Refractory Obsessive-Compulsive Disorder: Case Report. Neurosurgery 2020; 86:E558-E563. [PMID: 31313803 DOI: 10.1093/neuros/nyz285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder, mainly treated with psychotherapy and pharmacotherapy. Surgical intervention may be appropriate for patients with treatment-refractory OCD. Deep brain stimulation (DBS) is an alternative for previously common ablative surgical procedures. Tractography has been proposed as a method for individualizing DBS treatment and may have the potential to improve efficacy. CLINICAL PRESENTATION We present a patient with treatment-refractory OCD previously treated with bilateral leucotomies, who underwent DBS surgery with targeting informed by tractography. Preoperative tractography to identify suitable DBS targets was undertaken. Structural images were also utilized for standard stereotactic surgical planning. The anteromedial globus pallidus internus (amGPi) was chosen as the target bilaterally after consideration of white matter projections to frontal cortical regions and neurosurgical approach. Bilateral amGPi DBS surgery was undertaken without adverse events. At 16-mo follow-up, there was a 48.5% reduction in OCD symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. CONCLUSION The amGPi can be a successful DBS target for OCD. This is the first known case to report on DBS surgery postleucotomies for OCD and highlights the utility of tractography for surgical planning in OCD.
Collapse
Affiliation(s)
- Amit Azriel
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Sarah Farrand
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Maria Di Biase
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia.,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Elaine Lui
- Department of Radiology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Patricia Desmond
- Department of Radiology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Mohammed Awad
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Samuel Moscovici
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Richard G Bittar
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia.,Deakin University, Victoria, Australia.,Precision Brain Spine and Pain Centre, Kew, Victoria, Australia
| |
Collapse
|
11
|
Grier MD, Zimmermann J, Heilbronner SR. Estimating Brain Connectivity With Diffusion-Weighted Magnetic Resonance Imaging: Promise and Peril. Biol Psychiatry Cogn Neurosci Neuroimaging 2020; 5:846-854. [PMID: 32513555 PMCID: PMC7483308 DOI: 10.1016/j.bpsc.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/20/2020] [Accepted: 04/18/2020] [Indexed: 01/22/2023]
Abstract
Diffusion-weighted magnetic resonance imaging (dMRI) is a popular tool for noninvasively assessing properties of white matter in the brain. Among other uses, dMRI data can be used to produce estimates of anatomical connectivity on the basis of tractography. However, direct comparisons of anatomical connectivity as estimated through invasive neural tract-tracing experiments and dMRI-derived connectivity have shown only a moderate relationship in nonhuman primate (particularly macaque) studies. Tractography is plagued by known problems associated with resolution, crossing fibers, and curving fibers, among others. These problems lead to deficits in both sensitivity and specificity, which trade off with each other in multiple datasets. Although not yet examined quantitatively, there is reason to believe that some large white matter bundles, those with more topographic organization, may produce more accurate results than others. Moving forward, sophisticated analytical approaches and anatomical constraints may improve tractography accuracy. However, broadly speaking, dMRI-derived estimates of brain connectivity should be approached with caution.
Collapse
Affiliation(s)
- Mark D Grier
- Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota
| | - Jan Zimmermann
- Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Sarah R Heilbronner
- Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota.
| |
Collapse
|
12
|
Frizon LA, Yamamoto EA, Nagel SJ, Simonson MT, Hogue O, Machado AG. Deep Brain Stimulation for Pain in the Modern Era: A Systematic Review. Neurosurgery 2020; 86:191-202. [PMID: 30799493 DOI: 10.1093/neuros/nyy552] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 01/25/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) has been considered for patients with intractable pain syndromes since the 1950s. Although there is substantial experience reported in the literature, the indications are contested, especially in the United States where it remains off-label. Historically, the sensory-discriminative pain pathways were targeted. More recently, modulation of the affective sphere of pain has emerged as a plausible alternative. OBJECTIVE To systematically review the literature from studies that used contemporary DBS technology. Our aim is to summarize the current evidence of this therapy. METHODS A systematic search was conducted in the MEDLINE, EMBASE, and Cochrane libraries through July 2017 to review all studies using the current DBS technology primarily for pain treatment. Study characteristics including patient demographics, surgical technique, outcomes, and complications were collected. RESULTS Twenty-two articles were included in this review. In total, 228 patients were implanted with a definitive DBS system for pain. The most common targets used were periaqueductal/periventricular gray matter region, ventral posterior lateral/posterior medial thalamus, or both. Poststroke pain, phantom limb pain, and brachial plexus injury were the most common specific indications for DBS. Outcomes varied between studies and across chronic pain diagnoses. Two different groups of investigators targeting the affective sphere of pain have demonstrated improvements in quality of life measures without significant reductions in pain scores. CONCLUSION DBS outcomes for chronic pain are heterogeneous thus far. Future studies may focus on specific pain diagnosis rather than multiple syndromes and consider randomized placebo-controlled designs. DBS targeting the affective sphere of pain seems promising and deserves further investigation.
Collapse
Affiliation(s)
- Leonardo A Frizon
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Post-graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Erin A Yamamoto
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Sean J Nagel
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
13
|
Gravbrot N, Saranathan M, Pouratian N, Kasoff W. Advanced Imaging and Direct Targeting of the Motor Thalamus and Dentato-Rubro-Thalamic Tract for Tremor: A Systematic Review. Stereotact Funct Neurosurg 2020; 98:220-240. [DOI: 10.1159/000507030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
|
14
|
Tohyama S, Walker MR, Sammartino F, Krishna V, Hodaie M. The Utility of Diffusion Tensor Imaging in Neuromodulation: Moving Beyond Conventional Magnetic Resonance Imaging. Neuromodulation 2020; 23:427-435. [DOI: 10.1111/ner.13107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/08/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Sarasa Tohyama
- Division of Brain, Imaging, and Behaviour–Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital University Health Network Toronto ON Canada
- Institute of Medical Science, Faculty of Medicine University of Toronto Toronto ON Canada
| | - Matthew R. Walker
- Division of Brain, Imaging, and Behaviour–Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital University Health Network Toronto ON Canada
| | - Francesco Sammartino
- Center for Neuromodulation, Department of Neurosurgery The Ohio State University Columbus OH USA
| | - Vibhor Krishna
- Center for Neuromodulation, Department of Neurosurgery The Ohio State University Columbus OH USA
| | - Mojgan Hodaie
- Division of Brain, Imaging, and Behaviour–Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital University Health Network Toronto ON Canada
- Institute of Medical Science, Faculty of Medicine University of Toronto Toronto ON Canada
- Department of Surgery, Faculty of Medicine University of Toronto Toronto ON Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital University Health Network Toronto ON Canada
| |
Collapse
|
15
|
Bao SC, Khan A, Song R, Kai-yu Tong R. Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration. J Stroke 2020; 22:47-63. [PMID: 32027791 PMCID: PMC7005350 DOI: 10.5853/jos.2019.03027] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.
Collapse
Affiliation(s)
- Shi-chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Ahsan Khan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong Song
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
16
|
Polanski WH, Zolal A, Klein J, Kitzler HH, Schackert G, Eisner W, Sobottka SB. Somatosensory functional MRI tractography for individualized targeting of deep brain stimulation in patients with chronic pain after brachial plexus injury. Acta Neurochir (Wien) 2019; 161:2485-2490. [PMID: 31591648 DOI: 10.1007/s00701-019-04065-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The optimal targets for deep brain stimulation (DBS) in patients with refractory chronic pain are not clearly defined. We applied sensory functional MRI (fMRI)- and diffusion tensor imaging (DTI)-based DBS in chronic pain patients into 3 different targets to ascertain the most beneficial individual stimulation site. METHODS Three patients with incapacitating chronic pain underwent DBS into 3 targets (periventricular gray (PVG), ventroposterolateral thalamus (VPL), and posterior limb of the internal capsule according to fMRI and DTI (PLIC). The electrodes were externalized and double-blinded tested for several days. Finally, the two electrodes with the best pain reduction were kept for permanent stimulation. The patients were then followed up for 12 months. Outcome measures comprised the numerical rating scale (NRS), short-form McGill's score (SF-MPQ), and health-related quality of life (SF-36). RESULTS Continuous pain (mean NRS 6.6) was reduced to NRS 3.6 after 12 months. Only with stimulation of the PLIC pain attacks, that occurred at least 3 times a week (mean NRS 9.6) resolved in 2 patients and improved in one patient concerning both intensity (NRS 5) and frequency (twice a month). The mean SF-MPQ decreased from 92.7 to 50. The health-related quality of life improved considerably. CONCLUSION fMRI- and DTI-based DBS to the PLIC was the only target with a significant effect on pain attacks and seems to be the most promising target in chronic pain patients after brachial plexus injury. The combination with PVG or VPL can further improve patients' outcome especially in terms of reducing the continuous pain.
Collapse
|
17
|
Abstract
Deep brain stimulation is the most advanced and effective neuromodulation therapy for Parkinson disease, essential tremor, and generalized dystonia. This article discusses how imaging improves surgical techniques and outcomes and widens possibilities in translational neuroscience in Parkinson disease, essential tremor, generalized dystonia, and epilepsy. In movement disorders diffusion tensor imaging allows anatomic segment of cortical areas and different functional subregions within deep-seated targets to understand the side effects of stimulation and gain more data to describe the therapeutic mechanism of action. The introduction of visualization of white matter tracks increases the safety of neurosurgical techniques in functional neurosurgery and neuro-oncology.
Collapse
Affiliation(s)
- Lorand Eross
- Department of Functional Neurosurgery, Center of Neuromodulation, National Institute of Clinical Neurosciences, Amerikai út 57, Budapest 1145, Hungary.
| | - Jonathan Riley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University Buffalo Medical, 955 Main Street, Buffalo, NY 14203, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University Buffalo, 955 Main Street, Buffalo, NY 14203, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University Buffalo, 955 Main Street, Buffalo, NY 14203, USA
| |
Collapse
|
18
|
Gong S, Xu M, Tao Y, Jin H, Liu Y, Sun X, Wang S, Yang X, Wang Y, Yuan L, Song W. Comparison of Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation Surgery on Parkinson Disease-Related Pain. World Neurosurg 2019; 135:e94-e99. [PMID: 31733388 DOI: 10.1016/j.wneu.2019.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To analyze and compare the effects of subthalamic nucleus (STN) deep brain stimulation (DBS) and globus pallidus internus (GPi)-DBS on Parkinson disease (PD)-related pain. METHODS A retrospective study was performed of 64 patients (28 who underwent GPi-DBS and 36 who underwent STN-DBS) with PD-related pain in our hospital between January 2017 and July 2019. A numerical rating scale (NRS) was used to evaluate the degree of pain preoperatively and 4 months after operation, and the unified PD scale III (UPDRS-III) was completed simultaneously to assess motor symptoms. RESULTS The average NRS score of all 64 patients after surgery was 1.09 ± 1.39, which was significantly lower than that before operation (4.44 ± 1.67; P < 0.0001). The improvement rate of NRS was 75 ± 27% in the 28 GPi-DBS patients and 79 ± 27% in the 36 STN-DBS patients, with no significant difference (P = 0.577). The improvements in NRS and UPDRS-III were significantly correlated in the STN-DBS group (r = 0.3707, P = 0.026) but not significantly correlated in the GPi-DBS group (P = 0.516). CONCLUSIONS Both GPi-DBS and STN-DBS were effective for analyzing PD-related pain and seemed to have similar efficacy. This study provides an important first-step toward determining different DBS targets for controlling PD-related pain. Follow-up prospective research is an appropriate next step on the path to multicenter clinical trials.
Collapse
Affiliation(s)
- Shun Gong
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Menting Xu
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Yingqun Tao
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China.
| | - Hai Jin
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Yang Liu
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Xiao Sun
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Shimiao Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Xingwang Yang
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Yu Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Lijia Yuan
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Weilong Song
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| |
Collapse
|
19
|
Franzini A, Messina G, Levi V, D'Ammando A, Cordella R, Moosa S, Prada F, Franzini A. Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review. J Neurosurg 2019; 133:1-9. [PMID: 31419792 DOI: 10.3171/2019.5.jns19227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Central poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb. METHODS Clinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview. RESULTS Four patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8-10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0-6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3-8). The mean percentage of long-term pain reduction was 38.13%. CONCLUSIONS This series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.
Collapse
Affiliation(s)
- Andrea Franzini
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
- 2Department of Neurosurgery, University of Virginia Health System; and
| | - Giuseppe Messina
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Vincenzo Levi
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Antonio D'Ammando
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Roberto Cordella
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| | - Shayan Moosa
- 2Department of Neurosurgery, University of Virginia Health System; and
| | - Francesco Prada
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
- 2Department of Neurosurgery, University of Virginia Health System; and
- 3Focused Ultrasound Foundation, Charlottesville, Virginia
| | - Angelo Franzini
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
| |
Collapse
|
20
|
De Vloo P, Nuttin B. Stereotaxy in rat models: Current state of the art, proposals to improve targeting accuracy and reporting guideline. Behav Brain Res 2019; 364:457-463. [DOI: 10.1016/j.bbr.2017.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 12/28/2022]
|
21
|
Elias GJB, Namasivayam AA, Lozano AM. Deep brain stimulation for stroke: Current uses and future directions. Brain Stimul 2017; 11:3-28. [PMID: 29089234 DOI: 10.1016/j.brs.2017.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/07/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of stroke often experience significant disability and impaired quality of life related to ongoing maladaptive responses and persistent neurologic deficits. Novel therapeutic options are urgently needed to augment current approaches. One way to promote recovery and ameliorate symptoms may be to electrically stimulate the surviving brain. Various forms of brain stimulation have been investigated for use in stroke, including deep brain stimulation (DBS). OBJECTIVE/METHODS We conducted a comprehensive literature review in order to 1) review the use of DBS to treat post-stroke maladaptive responses including pain, dystonia, dyskinesias, and tremor and 2) assess the use and potential utility of DBS for enhancing plasticity and recovery from post-stroke neurologic deficits. RESULTS/CONCLUSIONS A large variety of brain structures have been targeted in post-stroke patients, including motor thalamus, sensory thalamus, basal ganglia nuclei, internal capsule, and periventricular/periaqueductal grey. Overall, the reviewed clinical literature suggests a role for DBS in the management of several post-stroke maladaptive responses. More limited evidence was identified regarding DBS for post-stroke motor deficits, although existing work tentatively suggests DBS-particularly DBS targeting the posterior limb of the internal capsule-may improve paresis in certain circumstances. Substantial future work is required both to establish optimal targets and parameters for treatment of maladapative responses and to further investigate the effectiveness of DBS for post-stroke paresis.
Collapse
Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andrew A Namasivayam
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada.
| |
Collapse
|
22
|
Abstract
Introduction Recent advances in surgical imaging include the use of diffusion tensor imaging (DTI) in deep brain stimulation (DBS) and provide a detailed view of the white matter tracts and their connections which are not seen with conventional magnetic resonance imaging. Given that the efficacy of DBS depends on the precise and accurate targeting of these circuits, better surgical planning using information obtained from DTI may lead to improved surgical outcome. We aim to review the available literature to evaluate the efficacy of such a strategy. Methods A search of PubMed was performed to identify all articles using the search terms “(diffusion tractography OR diffusion tensor imaging OR DTI) AND (deep brain stimulation OR DBS).” Studies were included if DTI was used and clinical outcomes were reported. Results We identified 35 studies where the use of DTI in DBS was evaluated. The most studied pathology was movement disorders (17 studies), psychiatric disorders (11 studies), and pain (7 studies). The overall responder rates for tremor reduction was 70.0% (SD = 26.1%) in 69 patients, 36.5% (SD = 19.1%) for obsessive–compulsive disorder in 9 patients, 48.3% (SD = 40.0%) for depression in 40 patients, and 49.7% (SD = 35.1%) for chronic pain in 23 patients. Discussion The studies reviewed show that the use of DTI for surgical planning is feasible, provide additional information over conventional targeting methods, and can improve surgical outcome. Patients in whom the DBS electrodes were within the DTI targets experienced better outcomes than those in whom the electrodes were not. Many current studies are limited by their small sample size or retrospective nature. The use of DTI in DBS planning appears underutilized and further studies are warranted given that surgical outcome can be optimized using this non-invasive technique.
Collapse
Affiliation(s)
- Angela An Qi See
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
23
|
Affiliation(s)
- Karen-Amanda Irvine
- Veterans Affairs Palo Alto Health Care System, Anesthesiology Service, Palo Alto, California
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - J David Clark
- Veterans Affairs Palo Alto Health Care System, Anesthesiology Service, Palo Alto, California
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
24
|
Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O'Donnell LJ. White matter tractography for neurosurgical planning: A topography-based review of the current state of the art. Neuroimage Clin 2017; 15:659-672. [PMID: 28664037 PMCID: PMC5480983 DOI: 10.1016/j.nicl.2017.06.011] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
We perform a review of the literature in the field of white matter tractography for neurosurgical planning, focusing on those works where tractography was correlated with clinical information such as patient outcome, clinical functional testing, or electro-cortical stimulation. We organize the review by anatomical location in the brain and by surgical procedure, including both supratentorial and infratentorial pathologies, and excluding spinal cord applications. Where possible, we discuss implications of tractography for clinical care, as well as clinically relevant technical considerations regarding the tractography methods. We find that tractography is a valuable tool in variable situations in modern neurosurgery. Our survey of recent reports demonstrates multiple potentially successful applications of white matter tractography in neurosurgery, with progress towards overcoming clinical challenges of standardization and interpretation.
Collapse
Affiliation(s)
- Walid I Essayed
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Fan Zhang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Prashin Unadkat
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - G Rees Cosgrove
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren J O'Donnell
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
25
|
Sasada S, Agari T, Sasaki T, Kondo A, Shinko A, Wakamori T, Okazaki M, Kin I, Kuwahara K, Kameda M, Yasuhara T, Date I. Efficacy of Fiber Tractography in the Stereotactic Surgery of the Thalamus for Patients with Essential Tremor. Neurol Med Chir (Tokyo) 2017; 57:392-401. [PMID: 28458383 PMCID: PMC5566698 DOI: 10.2176/nmc.oa.2016-0277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several targets and targeting methods are utilized in stereotactic surgery to achieve tremor suppression for patients with intractable tremor. Recent developments in magnetic resonance imaging, including diffusion tensor imaging, have enabled the setting of appropriate targets in stereotactic surgery. In this retrospective study, the optimal target to suppress tremors in stereotactic surgery was explored using diffusion tensor image-based fiber tractography. Four tracts were focused on in this study, namely: the cerebello-thalamo-premotor cortical fiber tract, cerebello-thalamo-primary motor cortical fiber tract, spino-thalamo-somatosensory cortical fiber tract, and pyramidal tract. In 10 patients with essential tremor, we evaluated the thalamotomy lesions and active contacts of the lead in thalamic stimulation by diffusion tensor image-based fiber tractography to reveal which part of the cerebral cortex is most affected by stereotactic surgery. Tremor suppression and adverse events were also evaluated in the patients involved in this study. Consequently, the good tremor suppression was achieved in all patients. There had been no permanent adverse events 3 months after surgery. Twelve lesions in thalamotomy patients or active contacts of the lead in thalamic stimulation patients were on the cerebello-thalamo-premotor cortical fiber tract (12/14 lesions or active contacts: 86%). In conclusion, the cerebello-thalamo-premotor cortical fiber tract may be an optimal target for tremor suppression. Diffusion tensor image-based fiber tractography may enable us to both determine the optimal target to achieve strong tremor suppression and to reduce the number of adverse events by keeping lesions or electrodes away from important fiber tracts, such as the pyramidal tract and spinothalamic fibers.
Collapse
Affiliation(s)
- Susumu Sasada
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Takashi Agari
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Tatsuya Sasaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Akihiko Kondo
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Aiko Shinko
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Takaaki Wakamori
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Mihoko Okazaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Ittetsu Kin
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Ken Kuwahara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| |
Collapse
|
26
|
Coenen VA, Amtage F, Volkmann J, Schläpfer TE. Deep Brain Stimulation in Neurological and Psychiatric Disorders. Dtsch Arztebl Int 2016; 112:519-26. [PMID: 26334979 DOI: 10.3238/arztebl.2015.0519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is the chronic electrical stimulation of selected target sites in the brain through stereotactically implanted electrodes. More than 150 000 patients around the world have been treated to date with DBS for medically intractable conditions. The indications for DBS include movement disorders, epilepsy, and some types of mental illness. METHODS This review is based on relevant publications retrieved by a selective search in PubMed and the Cochrane Library, and on the current guidelines of the German Neurological Society (Deutsche Gesellschaft für Neurologie, DGN). RESULTS DBS is usually performed to treat neurological diseases, most often movement disorders and, in particular, Parkinson's disease. Multiple randomized controlled trials (RCTs) have shown that DBS improves tremor, dyskinesia, and quality of life in patients with Parkinson's disease by 25% to 50%, depending on the rating scales used. DBS for tremor usually involves stimulation in the cerebello-thalamo-cortical regulatory loop. In an RCT of DBS for the treatment of primary generalized dystonia, the patients who underwent DBS experienced a 39.3% improvement of dystonia, compared to only 4.9% in the control group. Two multicenter trials of DBS for depression were terminated early because of a lack of efficacy. CONCLUSION DBS is an established treatment for various neurological and psychiatric diseases. It has been incorporated in the DGN guidelines and is now considered a standard treatment for advanced Parkinson's disease. The safety and efficacy of DBS can be expected to improve with the application of new technical developments in electrode geometry and new imaging techniques. Controlled trials would be helpful so that DBS could be extended to further indications, particularly psychiatric ones.
Collapse
Affiliation(s)
- Volker A Coenen
- Abteilung Stereotaktische und Funktionelle Neurochirurgie, Universitätsklinikum der Albert-Ludwigs-Universität Freiburg, Klinik für Neurologie und Neurophysiologie, Albert-Ludwigs-Universität Freiburg, Neurologische Klinik und Poliklinik, Universit7auml;sklinikum Würzburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum
| | | | | | | |
Collapse
|
27
|
Rozanski VE, da Silva NM, Ahmadi SA, Mehrkens J, da Silva Cunha J, Houde JC, Vollmar C, Bötzel K, Descoteaux M. The role of the pallidothalamic fibre tracts in deep brain stimulation for dystonia: A diffusion MRI tractography study. Hum Brain Mapp 2016; 38:1224-1232. [PMID: 27862612 DOI: 10.1002/hbm.23450] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Deep Brain Stimulation (DBS) of the Globus pallidus internus (GPi) is gold standard treatment in medically refractory dystonia. Recent evidence indicates that stimulation effects are also due to axonal modulation and affection of a fibre network. For the GPi, the pallidothalamic tracts are known to be the major motor efferent pathways. The aim of this study is to explore the anatomic vicinity of these tracts and DBS electrodes in dystonia applying diffusion tractography. METHODS Diffusion MRI was acquired in ten patients presenting for DBS for dystonia. We applied both a conventionally used probabilistic tractography algorithm (FSL) as well as a probabilistic streamline tracking approach, based on constrained spherical deconvolution and particle filtering with anatomic priors, to the datasets. DBS electrodes were coregistered to the diffusion datasets. RESULTS We were able to delineate the pallidothalamic tracts in all patients. Using the streamline approach, we were able to distinguish between the two sub-components of the tracts, the ansa lenticularis and the fasciculus lenticularis. Clinically efficient DBS electrodes displayed a close anatomic vicinity pathway of the pallidothalamic tracts, and their course was consistent with previous tracer labelling studies. Although we present only anatomic data, we interpret these findings as evidence of the possible involvement of fibre tracts to the clinical effect in DBS. Electrophysiological intraoperative recordings would be needed to complement our findings. In the future, a clear and individual delineation of the pallidothalamic tracts could optimize the stereotactic process of optimal electrode localization. Hum Brain Mapp 38:1224-1232, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Nadia Moreira da Silva
- Department of Engineering, INESC TEC and Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, 4200-465, Portugal
| | - Seyed-Ahmad Ahmadi
- Department of Neurology, Klinikum Grosshadern, University of Munich, Germany
| | - Jan Mehrkens
- Department of Neurosurgery, Klinikum Grosshadern, University of Munich, Germany
| | - Joao da Silva Cunha
- Department of Engineering, INESC TEC and Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, 4200-465, Portugal
| | - Jean-Christophe Houde
- Department of Computer Science, Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science department, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Christian Vollmar
- Department of Neurology, Klinikum Grosshadern, University of Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Klinikum Grosshadern, University of Munich, Germany
| | - Maxime Descoteaux
- Department of Computer Science, Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science department, Université de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
28
|
Kim W, Chivukula S, Hauptman J, Pouratian N. Diffusion Tensor Imaging-Based Thalamic Segmentation in Deep Brain Stimulation for Chronic Pain Conditions. Stereotact Funct Neurosurg 2016; 94:225-234. [PMID: 27537848 DOI: 10.1159/000448079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/29/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Thalamic deep brain stimulation (DBS) for the treatment of medically refractory pain has largely been abandoned on account of its inconsistent and oftentimes poor efficacy. Our aim here was to use diffusion tensor imaging (DTI)-based segmentation to assess the internal thalamic nuclei of patients who have undergone thalamic DBS for intractable pain and retrospectively correlate lead position with clinical outcome. METHODS DTI-based segmentation was performed on 5 patients who underwent sensory thalamus DBS for chronic pain. Postoperative computed tomography images obtained for electrode placement were fused with preoperative magnetic resonance images that had undergone DTI-based thalamic segmentation. Sensory thalamus maps of 4 patients were analyzed for lead positioning and interpatient variability. RESULTS Four patients who experienced significant pain relief following DBS demonstrated contact positions within the DTI-determined sensory thalamus or in its vicinity, whereas 1 patient who did not respond to stimulation did not. Only 4 voxels (2%) within the sensory thalamus were mutually shared among patients; 108 voxels (58%) were uniquely represented. CONCLUSIONS DTI-based segmentation of the thalamus can be used to confirm thalamic lead placement relative to the sensory thalamus and may serve as a useful tool to guide thalamic DBS electrode implantation in the future.
Collapse
Affiliation(s)
- Won Kim
- Department of Neurological Surgery, University of California, Los Angeles, Calif., USA
| | | | | | | |
Collapse
|
29
|
Jakab A, Werner B, Piccirelli M, Kovács K, Martin E, Thornton JS, Yousry T, Szekely G, O'Gorman Tuura R. Feasibility of Diffusion Tractography for the Reconstruction of Intra-Thalamic and Cerebello-Thalamic Targets for Functional Neurosurgery: A Multi-Vendor Pilot Study in Four Subjects. Front Neuroanat 2016; 10:76. [PMID: 27462207 PMCID: PMC4940380 DOI: 10.3389/fnana.2016.00076] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/20/2016] [Indexed: 01/28/2023] Open
Abstract
Functional stereotactic neurosurgery by means of deep brain stimulation or ablation provides an effective treatment for movement disorders, but the outcome of surgical interventions depends on the accuracy by which the target structures are reached. The purpose of this pilot study was to evaluate the feasibility of diffusion tensor imaging (DTI) based probabilistic tractography of deep brain structures that are commonly used for pre- and perioperative targeting for functional neurosurgery. Three targets were reconstructed based on their significance as intervention sites or as a no-go area to avoid adverse side effects: the connections propagating from the thalamus to (1) primary and supplementary motor areas, (2) to somatosensory areas and the cerebello-thalamic tract (CTT). We evaluated the overlap of the reconstructed connectivity based targets with corresponding atlas based data, and tested the inter-subject and inter-scanner variability by acquiring repeated DTI from four volunteers, and on three MRI scanners with similar sequence parameters. Compared to a 3D histological atlas of the human thalamus, moderate overlaps of 35-50% were measured between connectivity- and atlas based volumes, while the minimal distance between the centerpoints of atlas and connectivity targets was 2.5 mm. The variability caused by the MRI scanner was similar to the inter-subject variability, except for connections with the postcentral gyrus where it was higher. While CTT resolved the anatomically correct trajectory of the tract individually, high volumetric variability was found across subjects and between scanners. DTI can be applied in the clinical, preoperative setting to reconstruct the CTT and to localize subdivisions within the lateral thalamus. In our pilot study, such subdivisions moderately matched the borders of the ventrolateral-posteroventral (VLpv) nucleus and the ventral-posterolateral (VPL) nucleus. Limitations of the currently used standard DTI protocols were exacerbated by large scanner-to-scanner variability of the connectivity-based targets.
Collapse
Affiliation(s)
- András Jakab
- Center for Magnetic Resonance Imaging Research, University Children's HospitalZürich, Switzerland; Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of ViennaVienna, Austria
| | - Beat Werner
- Center for Magnetic Resonance Imaging Research, University Children's Hospital Zürich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, University Hospital Zürich Zürich, Switzerland
| | - Kázmér Kovács
- Department of Biomedical Imaging and Laboratory Science, University of Debrecen Debrecen, Hungary
| | - Ernst Martin
- Center for Magnetic Resonance Imaging Research, University Children's Hospital Zürich, Switzerland
| | | | - Tarek Yousry
- University College London Institute of Neurology London, UK
| | - Gabor Szekely
- Computer Vision Laboratory, ETH Zürich Zürich, Switzerland
| | - Ruth O'Gorman Tuura
- Center for Magnetic Resonance Imaging Research, University Children's Hospital Zürich, Switzerland
| |
Collapse
|
30
|
Wagle Shukla A, Okun MS. State of the Art for Deep Brain Stimulation Therapy in Movement Disorders: A Clinical and Technological Perspective. IEEE Rev Biomed Eng 2016; 9:219-33. [PMID: 27411228 DOI: 10.1109/rbme.2016.2588399] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Deep brain stimulation (DBS) therapy is a widely used brain surgery that can be applied for many neurological and psychiatric disorders. DBS is American Food and Drug Administration approved for medication refractory Parkinson's disease, essential tremor and dystonia. Although DBS has shown consistent success in many clinical trials, the therapy has limitations and there are well-recognized complications. Thus, only carefully selected patients are ideal candidates for this surgery. Over the last two decades, there have been significant advances in clinical knowledge on DBS. In addition, the surgical techniques and technology related to DBS has been rapidly evolving. The goal of this review is to describe the current status of DBS in the context of movement disorders, outline the mechanisms of action for DBS in brief, discuss the standard surgical and imaging techniques, discuss the patient selection and clinical outcomes in each of the movement disorders, and finally, introduce the recent advancements from a clinical and technological perspective.
Collapse
|
31
|
Abstract
Deep brain stimulation (DBS) is believed to exert its therapeutic effects through modulation of brain circuitry, yet conventional preoperative planning does not allow direct targeting or visualization of white matter pathways. Diffusion MRI tractography (DT) is virtually the only non-invasive method of visualizing structural connectivity in the brain, leading many to suggest its use to guide DBS targeting. DT-guided DBS not only has the potential to allow direct white matter targeting for established applications [e.g., Parkinson’s disease (PD), essential tremor (ET), dystonia], but may also aid in the discovery of new therapeutic targets for a variety of other neurologic and psychiatric diseases. Despite these exciting opportunities, DT lacks standardization and rigorous anatomic validation, raising significant concern for the use of such data in stereotactic brain surgery. This review covers the technical details, proposed methods, and initial clinical data for the use of DT in DBS surgery. Rather than focusing on specific disease applications, this review focuses on methods that can be applied to virtually any DBS target.
Collapse
Affiliation(s)
- Evan Calabrese
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center Durham, NC, USA
| |
Collapse
|
32
|
Warbrick T, Fegers-Stollenwerk V, Maximov II, Grinberg F, Shah NJ. Using Structural and Functional Brain Imaging to Investigate Responses to Acute Thermal Pain. J Pain 2016; 17:836-44. [PMID: 27102895 DOI: 10.1016/j.jpain.2016.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/21/2016] [Accepted: 03/05/2016] [Indexed: 02/04/2023]
Abstract
UNLABELLED Despite a fundamental interest in the relationship between structure and function, the relationships between measures of white matter microstructural coherence and functional brain responses to pain are poorly understood. We investigated whether fractional anisotropy (FA) in 2 white matter regions in pathways associated with pain is related to the functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) response to thermal stimulation. BOLD fMRI was measured from 16 healthy male subjects during painful thermal stimulation of the right arm. Diffusion-weighted images were acquired for each subject and FA estimates were extracted from the posterior internal capsule and the cingulum (cingulate gyrus). These values were then included as covariates in the fMRI data analysis. We found BOLD response in the midcingulate cortex (MCC) to be positively related to FA in the posterior internal capsule and negatively related to FA in the cingulum. Our results suggest that the MCC's involvement in processing pain can be further delineated by considering how the magnitude of the BOLD response is related to white matter microstructural coherence and to subjective perception of pain. Considering relationships to white matter microstructural coherence in tracts involved in transmitting information to different parts of the pain network can help interpretation of MCC BOLD activation. PERSPECTIVE Relationships between functional brain responses, white matter microstructural coherence, and subjective ratings are crucial for understanding the role of the MCC in pain. These findings provide a basis for investigating the effect of the reduced white matter microstructural coherence observed in some pain disorders on the functional responses to pain.
Collapse
Affiliation(s)
- Tracy Warbrick
- Institute of Neuroscience and Medicine, Jülich, Germany.
| | | | | | - Farida Grinberg
- Institute of Neuroscience and Medicine, Jülich, Germany; Department of Neurology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine, Jülich, Germany; Department of Neurology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; Jülich Aachen Research Alliance (JARA) - Translational Brain Medicine, Aachen and Jülich, Germany
| |
Collapse
|
33
|
Djulejić V, Marinković S, Georgievski B, Stijak L, Aksić M, Puškaš L, Milić I. Clinical significance of blood supply to the internal capsule and basal ganglia. J Clin Neurosci 2016; 25:19-26. [DOI: 10.1016/j.jocn.2015.04.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/18/2015] [Indexed: 11/29/2022]
|
34
|
Son BC. Reply to the letter by Lévêque et al. Entitled 'simultaneous deep brain stimulation/motor cortex stimulation trial for neuropathic pain: fishing with dynamite?'. Stereotact Funct Neurosurg 2015; 93:220-1. [PMID: 25895903 DOI: 10.1159/000375436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Byung-Chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, and Catholic Neuroscience Institute, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
35
|
Coenen VA, Kieselbach K, Mader I, Reinacher PC. Diffusion tensor magnetic resonance imaging (DTI) tractography-guided deep brain stimulation in neuropathic pain. Acta Neurochir (Wien) 2015; 157:739-41. [PMID: 25652721 PMCID: PMC4365282 DOI: 10.1007/s00701-015-2356-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Centre, Breisacher Strasse 64, 79106, Freiburg i.Br., Germany,
| | | | | | | |
Collapse
|
36
|
Forster MT, Hoecker AC, Kang JS, Quick J, Seifert V, Hattingen E, Hilker R, Weise LM. Does Navigated Transcranial Stimulation Increase the Accuracy of Tractography? A Prospective Clinical Trial Based on Intraoperative Motor Evoked Potential Monitoring During Deep Brain Stimulation. Neurosurgery 2015; 76:766-75; discussion 775-6. [DOI: 10.1227/neu.0000000000000715] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractBACKGROUND:Tractography based on diffusion tensor imaging has become a popular tool for delineating white matter tracts for neurosurgical procedures.OBJECTIVE:To explore whether navigated transcranial magnetic stimulation (nTMS) might increase the accuracy of fiber tracking.METHODS:Tractography was performed according to both anatomic delineation of the motor cortex (n = 14) and nTMS results (n = 9). After implantation of the definitive electrode, stimulation via the electrode was performed, defining a stimulation threshold for eliciting motor evoked potentials recorded during deep brain stimulation surgery. Others have shown that of arm and leg muscles. This threshold was correlated with the shortest distance between the active electrode contact and both fiber tracks. Results were evaluated by correlation to motor evoked potential monitoring during deep brain stimulation, a surgical procedure causing hardly any brain shift.RESULTS:Distances to fiber tracks clearly correlated with motor evoked potential thresholds. Tracks based on nTMS had a higher predictive value than tracks based on anatomic motor cortex definition (P < .001 and P = .005, respectively). However, target site, hemisphere, and active electrode contact did not influence this correlation.CONCLUSION:The implementation of tractography based on nTMS increases the accuracy of fiber tracking. Moreover, this combination of methods has the potential to become a supplemental tool for guiding electrode implantation.
Collapse
Affiliation(s)
| | | | - Jun-Suk Kang
- Neurology, Goethe University Hospital, Frankfurt, Germany
| | - Johanna Quick
- Departments of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Departments of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Elke Hattingen
- Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Rüdiger Hilker
- Neurology, Goethe University Hospital, Frankfurt, Germany
| | - Lutz Martin Weise
- Departments of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| |
Collapse
|
37
|
|
38
|
Torres CV, Manzanares R, Sola RG. Integrating Diffusion Tensor Imaging-Based Tractography into Deep Brain Stimulation Surgery: A Review of the Literature. Stereotact Funct Neurosurg 2014; 92:282-90. [DOI: 10.1159/000362937] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022]
|