Probabilistic analysis of activation volumes generated during deep brain stimulation

• Published in: NeuroImage (Orlando, Fla.) Fla.), 2011-02, Vol.54 (3), p.2096-2104
• Main Authors: Butson, Christopher R., Cooper, Scott E., Henderson, Jaimie M., Wolgamuth, Barbara, McIntyre, Cameron C.
• Format: Article
• Language: English
• Subjects: Aged; Atlases as Topic; Brain - anatomy & histology; Clinical outcomes; Cohort Studies; Computational model; Computer Simulation; Data Interpretation, Statistical; Deep Brain Stimulation - adverse effects; Electric Stimulation; Electrodes; Female; Functional Laterality - physiology; Humans; Hypokinesia - etiology; Hypokinesia - physiopathology; Hypokinesia - therapy; Magnetic Resonance Imaging; Male; Methods; Middle Aged; Models, Neurological; Models, Statistical; Muscle Rigidity - etiology; Muscle Rigidity - therapy; Neuromodulation; Neurostimulation; Nonlinear Dynamics; Parkinson Disease - pathology; Parkinson Disease - therapy; Parkinson's disease; Patients; Subthalamic nucleus; Subthalamic Nucleus - physiology; Treatment Outcome
• ISSN: 1053-8119; 1095-9572
• DOI: 10.1016/j.neuroimage.2010.10.059

Deep brain stimulation (DBS) is an established therapy for the treatment of Parkinson's disease (PD) and shows great promise for the treatment of several other disorders. However, while the clinical analysis of DBS has received great attention, a relative paucity of quantitative techniques exists to define the optimal surgical target and most effective stimulation protocol for a given disorder. In this study we describe a methodology that represents an evolutionary addition to the concept of a probabilistic brain atlas, which we call a probabilistic stimulation atlas (PSA). We outline steps to combine quantitative clinical outcome measures with advanced computational models of DBS to identify regions where stimulation-induced activation could provide the best therapeutic improvement on a per-symptom basis. While this methodology is relevant to any form of DBS, we present example results from subthalamic nucleus (STN) DBS for PD. We constructed patient-specific computer models of the volume of tissue activated (VTA) for 163 different stimulation parameter settings which were tested in six patients. We then assigned clinical outcome scores to each VTA and compiled all of the VTAs into a PSA to identify stimulation-induced activation targets that maximized therapeutic response with minimal side effects. The results suggest that selection of both electrode placement and clinical stimulation parameter settings could be tailored to the patient's primary symptoms using patient-specific models and PSAs. ►Probabilistic stimulation atlas for deep brain stimulation. ►Patient-specific computational models define volume of tissue activated. ►Activation volumes coupled with clinical outcomes measures to define target stimulation regions. ►DBS for Parkinson's disease is associated with target volumes dorsal to the subthalamic nucleus.