RT Journal Article
SR Electronic
T1 Explaining Clinical Effects of Deep Brain Stimulation through Simplified Target-Specific Modeling of the Volume of Activated Tissue
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1072
OP 1080
DO 10.3174/ajnr.A2906
VO 33
IS 6
A1 B. Mädler
A1 V.A. Coenen
YR 2012
UL http://www.ajnr.org/content/33/6/1072.abstract
AB BACKGROUND AND PURPOSE: Although progress has been made in understanding the optimal anatomic structures as target areas for DBS, little effort has been put into modeling and predicting electromagnetic field properties of activated DBS electrodes and understanding their interactions with the adjacent tissue. Currently, DBS is performed with the patient awake to assess the effectiveness and the side effect spectrum of stimulation. This study was designed to create a robust and rather simple numeric and visual tool that provides sufficient and practical relevant information to visualize the patient's individual VAT. MATERIALS AND METHODS: Multivariate polynomial fitting of previously obtained data from a finite-element model, based on a similar DBS system, was used. The model estimates VAT as a first-approximation sphere around the active DBS contact, using stimulation voltages and individual tissue-electrode impedances. Validation uses data from 2 patients with PD by MR imaging, DTI, fiber tractography, and postoperative CT data. RESULTS: Our model can predict VAT for impedances between 500 and 2000 Ω with stimulation voltages up to 10 V. It is based on assumptions for monopolar DBS. Evaluation of 2 DBS cases showed a convincing correspondence between predicted VAT and neurologic (side) effects (internal capsule activation). CONCLUSIONS: Stimulation effects during DBS can be readily explained with this simple VAT model. Its implementation in daily clinical routine might help in understanding the types of tissues activated during DBS. This technique might have the potential to facilitate DBS implantations with the patient under general anesthesia while yielding acceptable clinical effectiveness. DBSdeep brain stimulationDRTdentatorubrothalamic tractIPGinternal pulse generatorMLmedial lemniscusMPRAGEmagnetization-prepared rapid acquisition of gradient echoPDParkinson diseasePTpyramidal tractsRNred nucleusrVATradius of volume of activated tissueSENSEsensitivity encodingSNrsubstantia nigraSTNsubthalamic nucleusVATvolume of activated tissue