A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors.
Identifieur interne : 000043 ( PubMed/Corpus ); précédent : 000042; suivant : 000044A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors.
Auteurs : Ashesh Shah ; Jérôme Coste ; Jean-Jacques Lemaire ; Erik Schkommodau ; Ethan Taub ; Raphael Guzman ; Philippe Derost ; Simone HemmSource :
- Journal of neurosurgery [ 1933-0693 ] ; 2016.
Abstract
OBJECTIVE Despite the widespread use of deep brain stimulation (DBS) for movement disorders such as Parkinson's disease (PD), the exact anatomical target responsible for the therapeutic effect is still a subject of research. Intraoperative stimulation tests by experts consist of performing passive movements of the patient's arm or wrist while the amplitude of the stimulation current is increased. At each position, the amplitude that best alleviates rigidity is identified. Intrarater and interrater variations due to the subjective and semiquantitative nature of such evaluations have been reported. The aim of the present study was to evaluate the use of an acceleration sensor attached to the evaluator's wrist to assess the change in rigidity, hypothesizing that such a change will alter the speed of the passive movements. Furthermore, the combined analysis of such quantitative results with anatomy would generate a more reproducible description of the most effective stimulation sites. METHODS To test the reliability of the method, it was applied during postoperative follow-up examinations of 3 patients. To study the feasibility of intraoperative use, it was used during 9 bilateral DBS operations in patients suffering from PD. Changes in rigidity were calculated by extracting relevant outcome measures from the accelerometer data. These values were used to identify rigidity-suppressing stimulation current amplitudes, which were statistically compared with the amplitudes identified by the neurologist. Positions for the chronic DBS lead implantation that would have been chosen based on the acceleration data were compared with clinical choices. The data were also analyzed with respect to the anatomical location of the stimulating electrode. RESULTS Outcome measures extracted from the accelerometer data were reproducible for the same evaluator, thus providing a reliable assessment of rigidity changes during intraoperative stimulation tests. Of the 188 stimulation sites analyzed, the number of sites where rigidity-suppressing amplitudes were found increased from 144 to 170 when the accelerometer evaluations were considered. In general, rigidity release could be observed at significantly lower amplitudes with accelerometer evaluation (mean 0.9 ± 0.6 mA) than with subjective evaluation (mean 1.4 ± 0.6 mA) (p < 0.001). Of 14 choices for the implant location of the DBS lead, only 2 were the same for acceleration-based and subjective evaluations. The comparison across anatomical locations showed that stimulation in the fields of Forel ameliorates rigidity at similar amplitudes as stimulation in the subthalamic nucleus, but with fewer side effects. CONCLUSIONS This article describes and validates a new assistive method for assessing rigidity with acceleration sensors during intraoperative stimulation tests in DBS procedures. The initial results indicate that the proposed method may be a clinically useful aid for optimal DBS lead placement as well as a new tool in the ongoing scientific search for the optimal DBS target for PD.
DOI: 10.3171/2016.8.JNS152770
PubMed: 27982769
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors.</title><author><name sortKey="Shah, Ashesh" sort="Shah, Ashesh" uniqKey="Shah A" first="Ashesh" last="Shah">Ashesh Shah</name><affiliation><nlm:affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</nlm:affiliation></affiliation></author><author><name sortKey="Coste, Jerome" sort="Coste, Jerome" uniqKey="Coste J" first="Jérôme" last="Coste">Jérôme Coste</name><affiliation><nlm:affiliation>Image-Guided Clinical Neuroscience and Connectomics, and.</nlm:affiliation></affiliation></author><author><name sortKey="Lemaire, Jean Jacques" sort="Lemaire, Jean Jacques" uniqKey="Lemaire J" first="Jean-Jacques" last="Lemaire">Jean-Jacques Lemaire</name><affiliation><nlm:affiliation>Image-Guided Clinical Neuroscience and Connectomics, and.</nlm:affiliation></affiliation></author><author><name sortKey="Schkommodau, Erik" sort="Schkommodau, Erik" uniqKey="Schkommodau E" first="Erik" last="Schkommodau">Erik Schkommodau</name><affiliation><nlm:affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</nlm:affiliation></affiliation></author><author><name sortKey="Taub, Ethan" sort="Taub, Ethan" uniqKey="Taub E" first="Ethan" last="Taub">Ethan Taub</name><affiliation><nlm:affiliation>Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Guzman, Raphael" sort="Guzman, Raphael" uniqKey="Guzman R" first="Raphael" last="Guzman">Raphael Guzman</name><affiliation><nlm:affiliation>Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Derost, Philippe" sort="Derost, Philippe" uniqKey="Derost P" first="Philippe" last="Derost">Philippe Derost</name><affiliation><nlm:affiliation>Neuro-Psycho-Pharmacologie des Systèmes Dopaminergiques Sous-Corticaux, Université Clermont Auvergne, Université d'Auvergne; and.</nlm:affiliation></affiliation></author><author><name sortKey="Hemm, Simone" sort="Hemm, Simone" uniqKey="Hemm S" first="Simone" last="Hemm">Simone Hemm</name><affiliation><nlm:affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2016">2016</date><idno type="RBID">pubmed:27982769</idno><idno type="pmid">27982769</idno><idno type="doi">10.3171/2016.8.JNS152770</idno><idno type="wicri:Area/PubMed/Corpus">000043</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000043</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors.</title><author><name sortKey="Shah, Ashesh" sort="Shah, Ashesh" uniqKey="Shah A" first="Ashesh" last="Shah">Ashesh Shah</name><affiliation><nlm:affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</nlm:affiliation></affiliation></author><author><name sortKey="Coste, Jerome" sort="Coste, Jerome" uniqKey="Coste J" first="Jérôme" last="Coste">Jérôme Coste</name><affiliation><nlm:affiliation>Image-Guided Clinical Neuroscience and Connectomics, and.</nlm:affiliation></affiliation></author><author><name sortKey="Lemaire, Jean Jacques" sort="Lemaire, Jean Jacques" uniqKey="Lemaire J" first="Jean-Jacques" last="Lemaire">Jean-Jacques Lemaire</name><affiliation><nlm:affiliation>Image-Guided Clinical Neuroscience and Connectomics, and.</nlm:affiliation></affiliation></author><author><name sortKey="Schkommodau, Erik" sort="Schkommodau, Erik" uniqKey="Schkommodau E" first="Erik" last="Schkommodau">Erik Schkommodau</name><affiliation><nlm:affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</nlm:affiliation></affiliation></author><author><name sortKey="Taub, Ethan" sort="Taub, Ethan" uniqKey="Taub E" first="Ethan" last="Taub">Ethan Taub</name><affiliation><nlm:affiliation>Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Guzman, Raphael" sort="Guzman, Raphael" uniqKey="Guzman R" first="Raphael" last="Guzman">Raphael Guzman</name><affiliation><nlm:affiliation>Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Derost, Philippe" sort="Derost, Philippe" uniqKey="Derost P" first="Philippe" last="Derost">Philippe Derost</name><affiliation><nlm:affiliation>Neuro-Psycho-Pharmacologie des Systèmes Dopaminergiques Sous-Corticaux, Université Clermont Auvergne, Université d'Auvergne; and.</nlm:affiliation></affiliation></author><author><name sortKey="Hemm, Simone" sort="Hemm, Simone" uniqKey="Hemm S" first="Simone" last="Hemm">Simone Hemm</name><affiliation><nlm:affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Journal of neurosurgery</title><idno type="eISSN">1933-0693</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE Despite the widespread use of deep brain stimulation (DBS) for movement disorders such as Parkinson's disease (PD), the exact anatomical target responsible for the therapeutic effect is still a subject of research. Intraoperative stimulation tests by experts consist of performing passive movements of the patient's arm or wrist while the amplitude of the stimulation current is increased. At each position, the amplitude that best alleviates rigidity is identified. Intrarater and interrater variations due to the subjective and semiquantitative nature of such evaluations have been reported. The aim of the present study was to evaluate the use of an acceleration sensor attached to the evaluator's wrist to assess the change in rigidity, hypothesizing that such a change will alter the speed of the passive movements. Furthermore, the combined analysis of such quantitative results with anatomy would generate a more reproducible description of the most effective stimulation sites. METHODS To test the reliability of the method, it was applied during postoperative follow-up examinations of 3 patients. To study the feasibility of intraoperative use, it was used during 9 bilateral DBS operations in patients suffering from PD. Changes in rigidity were calculated by extracting relevant outcome measures from the accelerometer data. These values were used to identify rigidity-suppressing stimulation current amplitudes, which were statistically compared with the amplitudes identified by the neurologist. Positions for the chronic DBS lead implantation that would have been chosen based on the acceleration data were compared with clinical choices. The data were also analyzed with respect to the anatomical location of the stimulating electrode. RESULTS Outcome measures extracted from the accelerometer data were reproducible for the same evaluator, thus providing a reliable assessment of rigidity changes during intraoperative stimulation tests. Of the 188 stimulation sites analyzed, the number of sites where rigidity-suppressing amplitudes were found increased from 144 to 170 when the accelerometer evaluations were considered. In general, rigidity release could be observed at significantly lower amplitudes with accelerometer evaluation (mean 0.9 ± 0.6 mA) than with subjective evaluation (mean 1.4 ± 0.6 mA) (p < 0.001). Of 14 choices for the implant location of the DBS lead, only 2 were the same for acceleration-based and subjective evaluations. The comparison across anatomical locations showed that stimulation in the fields of Forel ameliorates rigidity at similar amplitudes as stimulation in the subthalamic nucleus, but with fewer side effects. CONCLUSIONS This article describes and validates a new assistive method for assessing rigidity with acceleration sensors during intraoperative stimulation tests in DBS procedures. The initial results indicate that the proposed method may be a clinically useful aid for optimal DBS lead placement as well as a new tool in the ongoing scientific search for the optimal DBS target for PD.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">27982769</PMID><DateCreated><Year>2016</Year><Month>12</Month><Day>16</Day></DateCreated><DateRevised><Year>2016</Year><Month>12</Month><Day>17</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1933-0693</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2016</Year><Month>Dec</Month><Day>16</Day></PubDate></JournalIssue><Title>Journal of neurosurgery</Title><ISOAbbreviation>J. Neurosurg.</ISOAbbreviation></Journal><ArticleTitle>A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors.</ArticleTitle><Pagination><MedlinePgn>1-11</MedlinePgn></Pagination><Abstract><AbstractText NlmCategory="UNASSIGNED">OBJECTIVE Despite the widespread use of deep brain stimulation (DBS) for movement disorders such as Parkinson's disease (PD), the exact anatomical target responsible for the therapeutic effect is still a subject of research. Intraoperative stimulation tests by experts consist of performing passive movements of the patient's arm or wrist while the amplitude of the stimulation current is increased. At each position, the amplitude that best alleviates rigidity is identified. Intrarater and interrater variations due to the subjective and semiquantitative nature of such evaluations have been reported. The aim of the present study was to evaluate the use of an acceleration sensor attached to the evaluator's wrist to assess the change in rigidity, hypothesizing that such a change will alter the speed of the passive movements. Furthermore, the combined analysis of such quantitative results with anatomy would generate a more reproducible description of the most effective stimulation sites. METHODS To test the reliability of the method, it was applied during postoperative follow-up examinations of 3 patients. To study the feasibility of intraoperative use, it was used during 9 bilateral DBS operations in patients suffering from PD. Changes in rigidity were calculated by extracting relevant outcome measures from the accelerometer data. These values were used to identify rigidity-suppressing stimulation current amplitudes, which were statistically compared with the amplitudes identified by the neurologist. Positions for the chronic DBS lead implantation that would have been chosen based on the acceleration data were compared with clinical choices. The data were also analyzed with respect to the anatomical location of the stimulating electrode. RESULTS Outcome measures extracted from the accelerometer data were reproducible for the same evaluator, thus providing a reliable assessment of rigidity changes during intraoperative stimulation tests. Of the 188 stimulation sites analyzed, the number of sites where rigidity-suppressing amplitudes were found increased from 144 to 170 when the accelerometer evaluations were considered. In general, rigidity release could be observed at significantly lower amplitudes with accelerometer evaluation (mean 0.9 ± 0.6 mA) than with subjective evaluation (mean 1.4 ± 0.6 mA) (p < 0.001). Of 14 choices for the implant location of the DBS lead, only 2 were the same for acceleration-based and subjective evaluations. The comparison across anatomical locations showed that stimulation in the fields of Forel ameliorates rigidity at similar amplitudes as stimulation in the subthalamic nucleus, but with fewer side effects. CONCLUSIONS This article describes and validates a new assistive method for assessing rigidity with acceleration sensors during intraoperative stimulation tests in DBS procedures. The initial results indicate that the proposed method may be a clinically useful aid for optimal DBS lead placement as well as a new tool in the ongoing scientific search for the optimal DBS target for PD.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Shah</LastName><ForeName>Ashesh</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Coste</LastName><ForeName>Jérôme</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Image-Guided Clinical Neuroscience and Connectomics, and.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Service de Neurochirurgie and.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lemaire</LastName><ForeName>Jean-Jacques</ForeName><Initials>JJ</Initials><AffiliationInfo><Affiliation>Image-Guided Clinical Neuroscience and Connectomics, and.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Service de Neurochirurgie and.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schkommodau</LastName><ForeName>Erik</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Taub</LastName><ForeName>Ethan</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Guzman</LastName><ForeName>Raphael</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Departments of Neurosurgery and Biomedicine, University Hospital of Basel, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Derost</LastName><ForeName>Philippe</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Neuro-Psycho-Pharmacologie des Systèmes Dopaminergiques Sous-Corticaux, Université Clermont Auvergne, Université d'Auvergne; and.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Service de Neurologie, CHU Clermont-Ferrand, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hemm</LastName><ForeName>Simone</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>12</Month><Day>16</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Neurosurg</MedlineTA><NlmUniqueID>0253357</NlmUniqueID><ISSNLinking>0022-3085</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">AmpQ = quantitatively identified rigidity-suppressing amplitude</Keyword><Keyword MajorTopicYN="N">AmpS = subjectively assessed amplitude</Keyword><Keyword MajorTopicYN="N">DBS = deep brain stimulation</Keyword><Keyword MajorTopicYN="N">FF = fields of Forel</Keyword><Keyword MajorTopicYN="N">MER = microelectrode recording</Keyword><Keyword MajorTopicYN="N">OR = operating room</Keyword><Keyword MajorTopicYN="N">PD = Parkinson's disease</Keyword><Keyword MajorTopicYN="N">Parkinson's disease</Keyword><Keyword MajorTopicYN="N">QC = quantitatively assessed change</Keyword><Keyword MajorTopicYN="N">S-EMG = surface electromyography</Keyword><Keyword MajorTopicYN="N">STN = subthalamic nucleus</Keyword><Keyword MajorTopicYN="N">USB = Universal Serial Bus</Keyword><Keyword MajorTopicYN="N">ZI = zona incerta</Keyword><Keyword MajorTopicYN="N">acceleration sensor</Keyword><Keyword MajorTopicYN="N">deep brain stimulation</Keyword><Keyword MajorTopicYN="N">fields of Forel</Keyword><Keyword MajorTopicYN="N">functional neurosurgery</Keyword><Keyword MajorTopicYN="N">intraoperative</Keyword><Keyword MajorTopicYN="N">quantification</Keyword><Keyword MajorTopicYN="N">rigidity</Keyword><Keyword MajorTopicYN="N">subthalamic nucleus</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>12</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>12</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2016</Year><Month>12</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">27982769</ArticleId><ArticleId IdType="doi">10.3171/2016.8.JNS152770</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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