Electrophysiological sweet spot mapping in deep brain stimulation for Parkinson's disease patients

IF 7.6 1区 医学 Q1 CLINICAL NEUROLOGY Brain Stimulation Pub Date : 2024-07-01 DOI:10.1016/j.brs.2024.05.013
Jana Peeters , Tine Van Bogaert , Alexandra Boogers , Robin Gransier , Jan Wouters , Philippe De Vloo , Wim Vandenberghe , Michael T. Barbe , Veerle Visser-Vandewalle , Bart Nuttin , Till A. Dembek , Myles Mc Laughlin
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Abstract

Background

Subthalamic deep brain stimulation (STN-DBS) is a well-established therapy to treat Parkinson's disease (PD). However, the STN-DBS sub-target remains debated. Recently, a white matter tract termed the hyperdirect pathway (HDP), directly connecting the motor cortex to STN, has gained interest as HDP stimulation is hypothesized to drive DBS therapeutic effects. Previously, we have investigated EEG-based evoked potentials (EPs) to better understand the neuroanatomical origins of the DBS clinical effect. We found a 3-ms peak (P3) relating to clinical benefit, and a 10-ms peak (P10) suggesting nigral side effects. Here, we aimed to investigate the neuroanatomical origins of DBS EPs using probabilistic mapping.

Methods

EPs were recorded using EEG whilst low-frequency stimulation was delivered at all DBS-contacts individually. Next, EPs were mapped onto the patients’ individual space and then transformed to MNI standard space. Using voxel-wise and fiber-wise probabilistic mapping, we determined hotspots/hottracts and coldspots/coldtracts for P3 and P10. Topography analysis was also performed to determine the spatial distribution of the DBS EPs.

Results

In all 13 patients (18 hemispheres), voxel- and fiber-wise probabilistic mapping resulted in a P3-hotspot/hottract centered on the posterodorsomedial STN border indicative of HDP stimulation, while the P10-hotspot/hottract covered large parts of the substantia nigra.

Conclusion

This study investigated EP-based probabilistic mapping in PD patients during STN-DBS, revealing a P3-hotspot/hottract in line with HDP stimulation and P10-hotspot/hottract related to nigral stimulation. Results from this study provide key evidence for an electrophysiological measure of HDP and nigral stimulation.

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帕金森病患者脑深部刺激的电生理甜点图。
背景:眼下丘脑下深部脑刺激(STN-DBS)是一种治疗帕金森病(PD)的成熟疗法。然而,STN-DBS 的子目标仍存在争议。最近,直接连接运动皮层和 STN 的白质束--超直达通路(HDP)--引起了人们的兴趣,因为 HDP 刺激被假定能驱动 DBS 治疗效果。此前,我们研究了基于脑电图的诱发电位(EPs),以更好地了解 DBS 临床效果的神经解剖学起源。我们发现一个 3 毫秒的峰值(P3)与临床疗效有关,而一个 10 毫秒的峰值(P10)则暗示着黑质的副作用。在此,我们旨在利用概率图谱研究 DBS EPs 的神经解剖起源:方法:使用脑电图记录 EPs,同时对所有 DBS 接触点分别进行低频刺激。然后,将 EPs 映射到患者的个体空间,再转换到 MNI 标准空间。通过体素和纤维概率映射,我们确定了 P3 和 P10 的热点/热点和冷点/冷点。我们还进行了拓扑分析,以确定 DBS EPs 的空间分布:结果:在所有 13 名患者(18 个半球)中,体素和纤维概率绘图结果显示,P3 热点/热点以 STN 后背内侧边界为中心,表明受到了 HDP 刺激,而 P10 热点/热点则覆盖了黑质的大部分区域:本研究对STN-DBS期间帕金森病患者基于EP的概率图谱进行了调查,发现P3热点/牵引与HDP刺激一致,而P10热点/牵引与黑质刺激相关。这项研究的结果为HDP和黑质刺激的电生理测量提供了关键证据。
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来源期刊
Brain Stimulation
Brain Stimulation 医学-临床神经学
CiteScore
13.10
自引率
9.10%
发文量
256
审稿时长
72 days
期刊介绍: Brain Stimulation publishes on the entire field of brain stimulation, including noninvasive and invasive techniques and technologies that alter brain function through the use of electrical, magnetic, radiowave, or focally targeted pharmacologic stimulation. Brain Stimulation aims to be the premier journal for publication of original research in the field of neuromodulation. The journal includes: a) Original articles; b) Short Communications; c) Invited and original reviews; d) Technology and methodological perspectives (reviews of new devices, description of new methods, etc.); and e) Letters to the Editor. Special issues of the journal will be considered based on scientific merit.
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