Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Objective With a growing appreciation for interindividual anatomical variability and patient‐specific brain connectivity, advanced imaging sequences offer the opportunity to directly visualize anatomical targets for deep brain stimulation (DBS). The lack of quantitative evidence demonstrating their...

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Bibliographic Details
Published in:Annals of neurology 2022-05, Vol.91 (5), p.613-628
Main Authors: Neudorfer, Clemens, Kroneberg, Daniel, Al‐Fatly, Bassam, Goede, Lukas, Kübler, Dorothee, Faust, Katharina, Rienen, Ursula, Tietze, Anna, Picht, Thomas, Herrington, Todd M., Middlebrooks, Erik H., Kühn, Andrea, Schneider, Gerd‐Helge, Horn, Andreas
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anatomy
Brain
Brain architecture
Deep brain stimulation
Deep Brain Stimulation - methods
Diffusion Tensor Imaging - methods
Essential Tremor - diagnostic imaging
Essential Tremor - therapy
Female
Humans
Male
Markers
Medical imaging
Middle Aged
Neural networks
Neuroimaging
Patients
Retrospective Studies
Stimulation
Substantia grisea
Substrates
Thalamus
Thalamus - diagnostic imaging
Tremor
Tremor (Muscular contraction)
Tremors
Variability
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Summary:Objective With a growing appreciation for interindividual anatomical variability and patient‐specific brain connectivity, advanced imaging sequences offer the opportunity to directly visualize anatomical targets for deep brain stimulation (DBS). The lack of quantitative evidence demonstrating their clinical utility, however, has hindered their broad implementation in clinical practice. Methods Using fast gray matter acquisition T1 inversion recovery (FGATIR) sequences, the present study identified a thalamic hypointensity that holds promise as a visual marker in DBS. To validate the clinical utility of the identified hypointensity, we retrospectively analyzed 65 patients (26 female, mean age = 69.1 ± 12.7 years) who underwent DBS in the treatment of essential tremor. We characterized its neuroanatomical substrates and evaluated the hypointensity's ability to predict clinical outcome using stimulation volume modeling and voxelwise mapping. Finally, we determined whether the hypointensity marker could predict symptom improvement on a patient‐specific level. Results Anatomical characterization suggested that the identified hypointensity constituted the terminal part of the dentatorubrothalamic tract. Overlap between DBS stimulation volumes and the hypointensity in standard space significantly correlated with tremor improvement (R2 = 0.16, p = 0.017) and distance to hotspots previously reported in the literature (R2 = 0.49, p = 7.9e‐4). In contrast, the amount of variance explained by other anatomical atlas structures was reduced. When accounting for interindividual neuroanatomical variability, the predictive power of the hypointensity increased further (R2 = 0.37, p = 0.002). Interpretation Our findings introduce and validate a novel imaging‐based marker attainable from FGATIR sequences that has the potential to personalize and inform targeting and programming in DBS for essential tremor. ANN NEUROL 2022;91:613–628
ISSN:0364-5134
1531-8249
DOI:10.1002/ana.26326