Defining a therapeutic target for pallidal deep brain stimulation for dystonia
Tyler Cheung MD
Cedars Sinai Medical Center, Department of Neurology, Los Angeles, CA
Search for more papers by this authorAngela M. Noecker
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
Search for more papers by this authorRon L. Alterman MD
Beth Israel–Deaconess Medical Center, Department of Neurosurgery, Boston, MA
Search for more papers by this authorCameron C. McIntyre PhD
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
Search for more papers by this authorCorresponding Author
Michele Tagliati MD
Cedars Sinai Medical Center, Department of Neurology, Los Angeles, CA
Address correspondence to Dr Tagliati, Department of Neurology, Cedars Sinai Medical Center, 127 South San Vincente Blvd, AHSP Suite A6318, Los Angeles, CA 90048. E-mail: [email protected]Search for more papers by this authorTyler Cheung MD
Cedars Sinai Medical Center, Department of Neurology, Los Angeles, CA
Search for more papers by this authorAngela M. Noecker
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
Search for more papers by this authorRon L. Alterman MD
Beth Israel–Deaconess Medical Center, Department of Neurosurgery, Boston, MA
Search for more papers by this authorCameron C. McIntyre PhD
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
Search for more papers by this authorCorresponding Author
Michele Tagliati MD
Cedars Sinai Medical Center, Department of Neurology, Los Angeles, CA
Address correspondence to Dr Tagliati, Department of Neurology, Cedars Sinai Medical Center, 127 South San Vincente Blvd, AHSP Suite A6318, Los Angeles, CA 90048. E-mail: [email protected]Search for more papers by this authorAbstract
Objective
To create a data-driven computational model that identifies brain regions most frequently influenced by successful deep brain stimulation (DBS) of the globus pallidus (GP) for advanced, medication-resistant, generalized dystonia.
Methods
We studied a retrospective cohort of 21 DYT1 primary dystonia patients treated for at least 1 year with bilateral pallidal DBS. We first created individual volume of tissue activation (VTA) models utilizing neuroimaging and postoperative stimulation and clinical data. These models were then combined into a standardized probabilistic dystonia stimulation atlas (DSA). Finally, we constructed a candidate target volume from electrodes demonstrating at least 75% improvement in contralateral symptoms, utilizing voxels stimulated by least 75% of these electrodes.
Results
Pallidal DBS resulted in a median contralateral hemibody improvement of 90% (mean = 83%, standard deviation [SD] = 20) after 1 year of treatment. Individual VTA models of the 42 active electrodes included in the study demonstrated a mean stimulation volume of 501mm3 ([SD] = 284). The resulting DSA showed that areas most frequently stimulated were located squarely in the middle of the posterior GP, with a common target volume measuring 153mm3.
Interpretation
Our results provide a map of the region of influence of therapeutic DBS for dystonia and represent a potential target to refine current methods of surgical planning and stimulation parameters selection. Based on their role in alleviating symptoms, these regions may also provide anatomical and physiological information relevant to disease models of dystonia. Further experimental and clinical studies will be needed to validate their importance. Ann Neurol 2014;76:22–30
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