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Probabilistic mapping of deep brain stimulation effects in essential tremor.
Neuroimage Clin. 2017; 13:164-173.NC

Abstract

OBJECTIVE

To create probabilistic stimulation maps (PSMs) of deep brain stimulation (DBS) effects on tremor suppression and stimulation-induced side-effects in patients with essential tremor (ET).

METHOD

Monopolar reviews from 16 ET-patients which consisted of over 600 stimulation settings were used to create PSMs. A spherical model of the volume of neural activation was used to estimate the spatial extent of DBS for each setting. All data was pooled and voxel-wise statistical analysis as well as nonparametric permutation testing was used to confirm the validity of the PSMs.

RESULTS

PSMs showed tremor suppression to be more pronounced by stimulation in the zona incerta (ZI) than in the ventral intermediate nucleus (VIM). Paresthesias and dizziness were most commonly associated with stimulation in the ZI and surrounding thalamic nuclei.

DISCUSSION

Our results support the assumption, that the ZI might be a very effective target for tremor suppression. However stimulation inside the ZI and in its close vicinity was also related to the occurrence of stimulation-induced side-effects, so it remains unclear whether the VIM or the ZI is the overall better target. The study demonstrates the use of PSMs for target selection and evaluation. While their accuracy has to be carefully discussed, they can improve the understanding of DBS effects and can be of use for other DBS targets in the therapy of neurological or psychiatric disorders as well. Furthermore they provide a priori information about expected DBS effects in a certain region and might be helpful to clinicians in programming DBS devices in the future.

Authors+Show Affiliations

Department of Neurology, University of Cologne, Cologne, Germany; Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.Department of Neurology, University of Cologne, Cologne, Germany.Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Medtronic Neuromodulation, Medtronic Eindhoven Design Center, Eindhoven, The Netherlands.Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.Department of Neurology, University of Cologne, Cologne, Germany.Department of Neurology, University of Cologne, Cologne, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27981031

Citation

Dembek, Till A., et al. "Probabilistic Mapping of Deep Brain Stimulation Effects in Essential Tremor." NeuroImage. Clinical, vol. 13, 2017, pp. 164-173.
Dembek TA, Barbe MT, Åström M, et al. Probabilistic mapping of deep brain stimulation effects in essential tremor. Neuroimage Clin. 2017;13:164-173.
Dembek, T. A., Barbe, M. T., Åström, M., Hoevels, M., Visser-Vandewalle, V., Fink, G. R., & Timmermann, L. (2017). Probabilistic mapping of deep brain stimulation effects in essential tremor. NeuroImage. Clinical, 13, 164-173.
Dembek TA, et al. Probabilistic Mapping of Deep Brain Stimulation Effects in Essential Tremor. Neuroimage Clin. 2017;13:164-173. PubMed PMID: 27981031.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Probabilistic mapping of deep brain stimulation effects in essential tremor. AU - Dembek,Till A, AU - Barbe,Michael T, AU - Åström,Mattias, AU - Hoevels,Mauritius, AU - Visser-Vandewalle,Veerle, AU - Fink,Gereon R, AU - Timmermann,Lars, Y1 - 2016/11/17/ PY - 2016/07/21/received PY - 2016/10/06/revised PY - 2016/11/16/accepted PY - 2016/12/17/entrez PY - 2016/12/17/pubmed PY - 2017/11/29/medline KW - DBS, Deep brain stimulation KW - Deep brain stimulation KW - ET, Essential tremor KW - Essential tremor KW - PSA, Posterior subthalamic area KW - PSM, Probabilistic stimulation map KW - Probabilistic mapping KW - VIM, Ventral intermediate nucleus KW - VNA, Volume of neural activation KW - ZI, Zona incerta KW - Zona incerta SP - 164 EP - 173 JF - NeuroImage. Clinical JO - Neuroimage Clin VL - 13 N2 - OBJECTIVE: To create probabilistic stimulation maps (PSMs) of deep brain stimulation (DBS) effects on tremor suppression and stimulation-induced side-effects in patients with essential tremor (ET). METHOD: Monopolar reviews from 16 ET-patients which consisted of over 600 stimulation settings were used to create PSMs. A spherical model of the volume of neural activation was used to estimate the spatial extent of DBS for each setting. All data was pooled and voxel-wise statistical analysis as well as nonparametric permutation testing was used to confirm the validity of the PSMs. RESULTS: PSMs showed tremor suppression to be more pronounced by stimulation in the zona incerta (ZI) than in the ventral intermediate nucleus (VIM). Paresthesias and dizziness were most commonly associated with stimulation in the ZI and surrounding thalamic nuclei. DISCUSSION: Our results support the assumption, that the ZI might be a very effective target for tremor suppression. However stimulation inside the ZI and in its close vicinity was also related to the occurrence of stimulation-induced side-effects, so it remains unclear whether the VIM or the ZI is the overall better target. The study demonstrates the use of PSMs for target selection and evaluation. While their accuracy has to be carefully discussed, they can improve the understanding of DBS effects and can be of use for other DBS targets in the therapy of neurological or psychiatric disorders as well. Furthermore they provide a priori information about expected DBS effects in a certain region and might be helpful to clinicians in programming DBS devices in the future. SN - 2213-1582 UR - https://www.unboundmedicine.com/medline/citation/27981031/Probabilistic_mapping_of_deep_brain_stimulation_effects_in_essential_tremor_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-1582(16)30227-3 DB - PRIME DP - Unbound Medicine ER -