Directional deep brain stimulation: an intraoperative double-blind pilot study
Identifieur interne : 000B99 ( PascalFrancis/Curation ); précédent : 000B98; suivant : 000C00Directional deep brain stimulation: an intraoperative double-blind pilot study
Auteurs : Claudio Pollo [Suisse] ; Alain Kaelin-Lang [Suisse] ; Markus F. Oertel [Suisse] ; Lennart Stieglitz [Suisse] ; Ethan Taub [Suisse] ; Peter Fuhr [Suisse] ; Andres M. Lozano [Canada] ; Andreas Raabe [Suisse] ; Michael Schüpbach [Suisse]Source :
- Brain [ 0006-8950 ] ; 2014.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Deep brain stimulation of different targets has been shown to drastically improve symptoms of a variety of neurological conditions. However, the occurrence of disabling side effects may limit the ability to deliver adequate amounts of current necessary to reach the maximal benefit. Computed models have suggested that reduction in electrode size and the ability to provide directional stimulation could increase the efficacy of such therapies. This has never been demonstrated in humans. In the present study, we assess the effect of directional stimulation compared to omnidirectional stimulation. Three different directions of stimulation as well as omnidirectional stimulation were tested intraoperatively in the subthalamic nucleus of 11 patients with Parkinson's disease and in the nucleus ventralis intermedius of two other subjects with essential tremor. At the trajectory chosen for implantation of the definitive electrode, we assessed the current threshold window between positive and side effects, defined as the therapeutic window. A computed finite element model was used to compare the volume of tissue activated when one directional electrode was stimulated, or in case of omnidirectional stimulation. All but one patient showed a benefit of directional stimulation compared to omnidirectional. A best direction of stimulation was observed in all the patients. The therapeutic window in the best direction was wider than the second best direction (P = 0.003) and wider than the third best direction (P = 0.002). Compared to omnidirectional direction, the therapeutic window in the best direction was 41.3% wider (P = 0.037). The current threshold producing meaningful therapeutic effect in the best direction was 0.67 mA (0.3-1.0 mA) and was 43% lower than in omnidirectional stimulation (P = 0.002). No complication as a result of insertion of the directional electrode or during testing was encountered. The computed model revealed a volume of tissue activated of 10.5 mm3 in omnidirectional mode, compared with 4.2 mm3 when only one electrode was used. Directional deep brain stimulation with a reduced electrode size applied intraoperatively in the subthalamic nucleus as well as in the nucleus ventralis intermedius of the thalamus significantly widened the therapeutic window and lowered the current needed for beneficial effects, compared to omnidirectional stimulation. The observed side effects related to direction of stimulation were consistent with the anatomical location of surrounding structures. This new approach opens the door to an improved deep brain stimulation therapy. Chronic implantation is further needed to confirm these findings.
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Oertel</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Stieglitz, Lennart" sort="Stieglitz, Lennart" uniqKey="Stieglitz L" first="Lennart" last="Stieglitz">Lennart Stieglitz</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Taub, Ethan" sort="Taub, Ethan" uniqKey="Taub E" first="Ethan" last="Taub">Ethan Taub</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Neurosurgery, Basel University Hospital</s1><s2>Basel</s2><s3>CHE</s3><sZ>5 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Fuhr, Peter" sort="Fuhr, Peter" uniqKey="Fuhr P" first="Peter" last="Fuhr">Peter Fuhr</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Neurology, Basel University Hospital</s1><s2>Basel</s2><s3>CHE</s3><sZ>6 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>7 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Raabe, Andreas" sort="Raabe, Andreas" uniqKey="Raabe A" first="Andreas" last="Raabe">Andreas Raabe</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Schupbach, Michael" sort="Schupbach, Michael" uniqKey="Schupbach M" first="Michael" last="Schüpbach">Michael Schüpbach</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Neurology, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">14-0175942</idno><date when="2014">2014</date><idno type="stanalyst">PASCAL 14-0175942 INIST</idno><idno type="RBID">Pascal:14-0175942</idno><idno type="wicri:Area/PascalFrancis/Corpus">000019</idno><idno type="wicri:Area/PascalFrancis/Curation">000B99</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Directional deep brain stimulation: an intraoperative double-blind pilot study</title><author><name sortKey="Pollo, Claudio" sort="Pollo, Claudio" uniqKey="Pollo C" first="Claudio" last="Pollo">Claudio Pollo</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Kaelin Lang, Alain" sort="Kaelin Lang, Alain" uniqKey="Kaelin Lang A" first="Alain" last="Kaelin-Lang">Alain Kaelin-Lang</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Neurology, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Oertel, Markus F" sort="Oertel, Markus F" uniqKey="Oertel M" first="Markus F." last="Oertel">Markus F. Oertel</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Stieglitz, Lennart" sort="Stieglitz, Lennart" uniqKey="Stieglitz L" first="Lennart" last="Stieglitz">Lennart Stieglitz</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Taub, Ethan" sort="Taub, Ethan" uniqKey="Taub E" first="Ethan" last="Taub">Ethan Taub</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Neurosurgery, Basel University Hospital</s1><s2>Basel</s2><s3>CHE</s3><sZ>5 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Fuhr, Peter" sort="Fuhr, Peter" uniqKey="Fuhr P" first="Peter" last="Fuhr">Peter Fuhr</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Neurology, Basel University Hospital</s1><s2>Basel</s2><s3>CHE</s3><sZ>6 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>7 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Raabe, Andreas" sort="Raabe, Andreas" uniqKey="Raabe A" first="Andreas" last="Raabe">Andreas Raabe</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author><author><name sortKey="Schupbach, Michael" sort="Schupbach, Michael" uniqKey="Schupbach M" first="Michael" last="Schüpbach">Michael Schüpbach</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Neurology, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Suisse</country></affiliation></author></analytic><series><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Deep brain stimulation</term><term>Double blind study</term><term>Electrodes</term><term>Intraoperative</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Tremor</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Tremblement</term><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Peropératoire</term><term>Etude double insu</term><term>Electrode</term><term>Stimulation cérébrale profonde</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Deep brain stimulation of different targets has been shown to drastically improve symptoms of a variety of neurological conditions. However, the occurrence of disabling side effects may limit the ability to deliver adequate amounts of current necessary to reach the maximal benefit. Computed models have suggested that reduction in electrode size and the ability to provide directional stimulation could increase the efficacy of such therapies. This has never been demonstrated in humans. In the present study, we assess the effect of directional stimulation compared to omnidirectional stimulation. Three different directions of stimulation as well as omnidirectional stimulation were tested intraoperatively in the subthalamic nucleus of 11 patients with Parkinson's disease and in the nucleus ventralis intermedius of two other subjects with essential tremor. At the trajectory chosen for implantation of the definitive electrode, we assessed the current threshold window between positive and side effects, defined as the therapeutic window. A computed finite element model was used to compare the volume of tissue activated when one directional electrode was stimulated, or in case of omnidirectional stimulation. All but one patient showed a benefit of directional stimulation compared to omnidirectional. A best direction of stimulation was observed in all the patients. The therapeutic window in the best direction was wider than the second best direction (P = 0.003) and wider than the third best direction (P = 0.002). Compared to omnidirectional direction, the therapeutic window in the best direction was 41.3% wider (P = 0.037). The current threshold producing meaningful therapeutic effect in the best direction was 0.67 mA (0.3-1.0 mA) and was 43% lower than in omnidirectional stimulation (P = 0.002). No complication as a result of insertion of the directional electrode or during testing was encountered. The computed model revealed a volume of tissue activated of 10.5 mm<sup>3</sup> in omnidirectional mode, compared with 4.2 mm<sup>3</sup> when only one electrode was used. Directional deep brain stimulation with a reduced electrode size applied intraoperatively in the subthalamic nucleus as well as in the nucleus ventralis intermedius of the thalamus significantly widened the therapeutic window and lowered the current needed for beneficial effects, compared to omnidirectional stimulation. The observed side effects related to direction of stimulation were consistent with the anatomical location of surrounding structures. This new approach opens the door to an improved deep brain stimulation therapy. Chronic implantation is further needed to confirm these findings.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0006-8950</s0></fA01><fA03 i2="1"><s0>Brain</s0></fA03><fA05><s2>137</s2></fA05><fA06><s3>p. 7</s3></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Directional deep brain stimulation: an intraoperative double-blind pilot study</s1></fA08><fA11 i1="01" i2="1"><s1>POLLO (Claudio)</s1></fA11><fA11 i1="02" i2="1"><s1>KAELIN-LANG (Alain)</s1></fA11><fA11 i1="03" i2="1"><s1>OERTEL (Markus F.)</s1></fA11><fA11 i1="04" i2="1"><s1>STIEGLITZ (Lennart)</s1></fA11><fA11 i1="05" i2="1"><s1>TAUB (Ethan)</s1></fA11><fA11 i1="06" i2="1"><s1>FUHR (Peter)</s1></fA11><fA11 i1="07" i2="1"><s1>LOZANO (Andres M.)</s1></fA11><fA11 i1="08" i2="1"><s1>RAABE (Andreas)</s1></fA11><fA11 i1="09" i2="1"><s1>SCHÜPBACH (Michael)</s1></fA11><fA14 i1="01"><s1>Department of Neurosurgery, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>8 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Neurology, Bern University Hospital, Inselspital</s1><s2>Bern</s2><s3>CHE</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Neurosurgery, Basel University Hospital</s1><s2>Basel</s2><s3>CHE</s3><sZ>5 aut.</sZ></fA14><fA14 i1="04"><s1>Department of Neurology, Basel University Hospital</s1><s2>Basel</s2><s3>CHE</s3><sZ>6 aut.</sZ></fA14><fA14 i1="05"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>7 aut.</sZ></fA14><fA20><s1>2015-2026</s1></fA20><fA21><s1>2014</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>998</s2><s5>354000501839620170</s5></fA43><fA44><s0>0000</s0><s1>© 2014 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>3/4 p.</s0></fA45><fA47 i1="01" i2="1"><s0>14-0175942</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Brain</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>Deep brain stimulation of different targets has been shown to drastically improve symptoms of a variety of neurological conditions. However, the occurrence of disabling side effects may limit the ability to deliver adequate amounts of current necessary to reach the maximal benefit. Computed models have suggested that reduction in electrode size and the ability to provide directional stimulation could increase the efficacy of such therapies. This has never been demonstrated in humans. In the present study, we assess the effect of directional stimulation compared to omnidirectional stimulation. Three different directions of stimulation as well as omnidirectional stimulation were tested intraoperatively in the subthalamic nucleus of 11 patients with Parkinson's disease and in the nucleus ventralis intermedius of two other subjects with essential tremor. At the trajectory chosen for implantation of the definitive electrode, we assessed the current threshold window between positive and side effects, defined as the therapeutic window. A computed finite element model was used to compare the volume of tissue activated when one directional electrode was stimulated, or in case of omnidirectional stimulation. All but one patient showed a benefit of directional stimulation compared to omnidirectional. A best direction of stimulation was observed in all the patients. The therapeutic window in the best direction was wider than the second best direction (P = 0.003) and wider than the third best direction (P = 0.002). Compared to omnidirectional direction, the therapeutic window in the best direction was 41.3% wider (P = 0.037). The current threshold producing meaningful therapeutic effect in the best direction was 0.67 mA (0.3-1.0 mA) and was 43% lower than in omnidirectional stimulation (P = 0.002). No complication as a result of insertion of the directional electrode or during testing was encountered. The computed model revealed a volume of tissue activated of 10.5 mm<sup>3</sup> in omnidirectional mode, compared with 4.2 mm<sup>3</sup> when only one electrode was used. Directional deep brain stimulation with a reduced electrode size applied intraoperatively in the subthalamic nucleus as well as in the nucleus ventralis intermedius of the thalamus significantly widened the therapeutic window and lowered the current needed for beneficial effects, compared to omnidirectional stimulation. The observed side effects related to direction of stimulation were consistent with the anatomical location of surrounding structures. This new approach opens the door to an improved deep brain stimulation therapy. Chronic implantation is further needed to confirm these findings.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17A01</s0></fC02><fC02 i1="02" i2="X"><s0>002B17G</s0></fC02><fC02 i1="03" i2="X"><s0>002B17F</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Tremblement</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Tremor</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Temblor</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Maladie de Parkinson</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Parkinson disease</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Peropératoire</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Intraoperative</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Peroperatorio</s0><s5>09</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Etude double insu</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Double blind study</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Estudio doble ciego</s0><s5>10</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Electrode</s0><s5>11</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Electrodes</s0><s5>11</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Electrodo</s0><s5>11</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Stimulation cérébrale profonde</s0><s4>CD</s4><s5>96</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Deep brain stimulation</s0><s4>CD</s4><s5>96</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Mouvement involontaire</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Involuntary movement</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Movimiento involuntario</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Trouble neurologique</s0><s5>39</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Neurological disorder</s0><s5>39</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Trastorno neurológico</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Pathologie de l'encéphale</s0><s5>40</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>40</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Syndrome extrapyramidal</s0><s5>41</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>41</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>42</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>42</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Pathologie du système nerveux central</s0><s5>43</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>43</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>43</s5></fC07><fN21><s1>216</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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