Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions
Deep Brain Stimulation (DBS) is an effective treatment for advanced Parkinson’s disease. However, identifying stimulation parameters, such as contact and current amplitudes, is time-consuming based on trial and error. Directional leads add more stimulation options and render this process more challe...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-11-01
|
| Series: | Frontiers in Human Neuroscience |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fnhum.2022.925283/full |
| _version_ | 1828214192388177920 |
|---|---|
| author | Simon Nordenström Katrin Petermann Ines Debove Andreas Nowacki Paul Krack Claudio Pollo T. A. Khoa Nguyen T. A. Khoa Nguyen |
| author_facet | Simon Nordenström Katrin Petermann Ines Debove Andreas Nowacki Paul Krack Claudio Pollo T. A. Khoa Nguyen T. A. Khoa Nguyen |
| author_sort | Simon Nordenström |
| collection | DOAJ |
| description | Deep Brain Stimulation (DBS) is an effective treatment for advanced Parkinson’s disease. However, identifying stimulation parameters, such as contact and current amplitudes, is time-consuming based on trial and error. Directional leads add more stimulation options and render this process more challenging with a higher workload for neurologists and more discomfort for patients. In this study, a sweet spot-guided algorithm was developed that automatically suggested stimulation parameters. These suggestions were retrospectively compared to clinical monopolar reviews. A cohort of 24 Parkinson’s disease patients underwent bilateral DBS implantation in the subthalamic nucleus at our center. First, the DBS’ leads were reconstructed with the open-source toolbox Lead-DBS. Second, a sweet spot for rigidity reduction was set as the desired stimulation target for programming. This sweet spot and estimations of the volume of tissue activated were used to suggest (i) the best lead level, (ii) the best contact, and (iii) the effect thresholds for full therapeutic effect for each contact. To assess these sweet spot-guided suggestions, the clinical monopolar reviews were considered as ground truth. In addition, the sweet spot-guided suggestions for best lead level and best contact were compared against reconstruction-guided suggestions, which considered the lead location with respect to the subthalamic nucleus. Finally, a graphical user interface was developed as an add-on to Lead-DBS and is publicly available. With the interface, suggestions for all contacts of a lead can be generated in a few seconds. The accuracy for suggesting the best out of four lead levels was 56%. These sweet spot-guided suggestions were not significantly better than reconstruction-guided suggestions (p = 0.3). The accuracy for suggesting the best out of eight contacts was 41%. These sweet spot-guided suggestions were significantly better than reconstruction-guided suggestions (p < 0.001). The sweet spot-guided suggestions of each contact’s effect threshold had a mean error of 1.2 mA. On an individual lead level, the suggestions can vary more with mean errors ranging from 0.3 to 4.8 mA. Further analysis is warranted to improve the sweet spot-guided suggestions and to account for more symptoms and stimulation-induced side effects. |
| first_indexed | 2024-04-12T15:00:39Z |
| format | Article |
| id | doaj.art-0920047f953c4e699e10f12709638c3b |
| institution | Directory Open Access Journal |
| issn | 1662-5161 |
| language | English |
| last_indexed | 2024-04-12T15:00:39Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Human Neuroscience |
| spelling | doaj.art-0920047f953c4e699e10f12709638c3b2022-12-22T03:28:05ZengFrontiers Media S.A.Frontiers in Human Neuroscience1662-51612022-11-011610.3389/fnhum.2022.925283925283Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestionsSimon Nordenström0Katrin Petermann1Ines Debove2Andreas Nowacki3Paul Krack4Claudio Pollo5T. A. Khoa Nguyen6T. A. Khoa Nguyen7Department of Neurosurgery, University Hospital Bern, Bern, SwitzerlandDepartment of Neurology, University Hospital Bern, Bern, SwitzerlandDepartment of Neurology, University Hospital Bern, Bern, SwitzerlandDepartment of Neurosurgery, University Hospital Bern, Bern, SwitzerlandDepartment of Neurology, University Hospital Bern, Bern, SwitzerlandDepartment of Neurosurgery, University Hospital Bern, Bern, SwitzerlandDepartment of Neurosurgery, University Hospital Bern, Bern, SwitzerlandARTORG Center for Biomedical Engineering Research, University Bern, Bern, SwitzerlandDeep Brain Stimulation (DBS) is an effective treatment for advanced Parkinson’s disease. However, identifying stimulation parameters, such as contact and current amplitudes, is time-consuming based on trial and error. Directional leads add more stimulation options and render this process more challenging with a higher workload for neurologists and more discomfort for patients. In this study, a sweet spot-guided algorithm was developed that automatically suggested stimulation parameters. These suggestions were retrospectively compared to clinical monopolar reviews. A cohort of 24 Parkinson’s disease patients underwent bilateral DBS implantation in the subthalamic nucleus at our center. First, the DBS’ leads were reconstructed with the open-source toolbox Lead-DBS. Second, a sweet spot for rigidity reduction was set as the desired stimulation target for programming. This sweet spot and estimations of the volume of tissue activated were used to suggest (i) the best lead level, (ii) the best contact, and (iii) the effect thresholds for full therapeutic effect for each contact. To assess these sweet spot-guided suggestions, the clinical monopolar reviews were considered as ground truth. In addition, the sweet spot-guided suggestions for best lead level and best contact were compared against reconstruction-guided suggestions, which considered the lead location with respect to the subthalamic nucleus. Finally, a graphical user interface was developed as an add-on to Lead-DBS and is publicly available. With the interface, suggestions for all contacts of a lead can be generated in a few seconds. The accuracy for suggesting the best out of four lead levels was 56%. These sweet spot-guided suggestions were not significantly better than reconstruction-guided suggestions (p = 0.3). The accuracy for suggesting the best out of eight contacts was 41%. These sweet spot-guided suggestions were significantly better than reconstruction-guided suggestions (p < 0.001). The sweet spot-guided suggestions of each contact’s effect threshold had a mean error of 1.2 mA. On an individual lead level, the suggestions can vary more with mean errors ranging from 0.3 to 4.8 mA. Further analysis is warranted to improve the sweet spot-guided suggestions and to account for more symptoms and stimulation-induced side effects.https://www.frontiersin.org/articles/10.3389/fnhum.2022.925283/fulldeep brain stimulationParkinson’s diseaseprogrammingsweet spotsubthalamic nucleus |
| spellingShingle | Simon Nordenström Katrin Petermann Ines Debove Andreas Nowacki Paul Krack Claudio Pollo T. A. Khoa Nguyen T. A. Khoa Nguyen Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions Frontiers in Human Neuroscience deep brain stimulation Parkinson’s disease programming sweet spot subthalamic nucleus |
| title | Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions |
| title_full | Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions |
| title_fullStr | Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions |
| title_full_unstemmed | Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions |
| title_short | Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions |
| title_sort | programming of subthalamic nucleus deep brain stimulation for parkinson s disease with sweet spot guided parameter suggestions |
| topic | deep brain stimulation Parkinson’s disease programming sweet spot subthalamic nucleus |
| url | https://www.frontiersin.org/articles/10.3389/fnhum.2022.925283/full |
| work_keys_str_mv | AT simonnordenstrom programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions AT katrinpetermann programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions AT inesdebove programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions AT andreasnowacki programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions AT paulkrack programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions AT claudiopollo programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions AT takhoanguyen programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions AT takhoanguyen programmingofsubthalamicnucleusdeepbrainstimulationforparkinsonsdiseasewithsweetspotguidedparametersuggestions |