Åström Mattias, Samuelsson Jennifer, Roothans Jonas, Fytagoridis Anders, Ryzhkov Maxim, Nijlunsing Rutger, Blomstedt Patric
Medtronic, Vasteras,
Medtronic, Eindhoven, The
Stereotact Funct Neurosurg. 2018;96(5):281-288. doi: 10.1159/000492230. Epub 2018 Sep 28.
BACKGROUND/AIM: Deep brain stimulation (DBS) is an established neurosurgical treatment that can be used to alleviate symptoms in essential tremor (ET) and other movement disorders. The aim was to develop a method and software tool for the prediction of effective DBS electrode contacts based on probabilistic stimulation maps (PSMs) in patients with ET treated with caudal zona incerta (cZi) DBS.
A total of 33 patients (37 leads) treated with DBS were evaluated with the Essential Tremor Rating Scale (ETRS) 12 months after surgery. In addition, hand tremor and hand function (ETRS items 5/6 and 11-14) were evaluated for every contact during stimulation with best possible outcome without inducing side effects. Prediction of effective DBS electrode contacts was carried out in a retrospective leave-one-out manner based on PSMs, simulated stimulation fields, and a scoring function. Electrode contacts were ranked according to their likelihood of being included in the clinical setting. Ranked electrode contacts were compared to actual clinical settings.
Predictions made by the software tool showed that electrode contacts with rank 1 matched the clinically used contacts in 60% of the cases. Contacts with a rank of 1-2 and 1-3 matched the clinical contacts in 83 and 94% of the cases, respectively. Mean improvement of hand tremor and hand function was 79 ± 21% and 77 ± 22% for the clinically used and the predicted electrode contacts, respectively.
Effective electrode contacts can be predicted based on PSMs in patients treated with cZi DBS for ET. Predictions may in the future be used to reduce the number of clinical assessments that are carried out before a satisfying stimulation setting is defined.
背景/目的：脑深部电刺激（DBS）是一种成熟的神经外科治疗方法，可用于缓解特发性震颤（ET）和其他运动障碍的症状。目的是开发一种基于概率刺激图谱（PSM）预测接受尾侧未定带（cZi）DBS治疗的ET患者有效DBS电极触点的方法和软件工具。
对33例接受DBS治疗的患者（37根电极导线）在术后12个月采用特发性震颤评定量表（ETRS）进行评估。此外，在刺激过程中，对每个触点的手部震颤和手部功能（ETRS项目5/6和11 - 14）进行评估，以获得最佳可能结果且不引发副作用。基于PSM、模拟刺激场和评分函数，以回顾性留一法对有效DBS电极触点进行预测。根据电极触点在临床应用中的可能性进行排序。将排序后的电极触点与实际临床应用情况进行比较。
软件工具做出的预测显示，排名第1的电极触点在60%的病例中与临床使用的触点相符。排名为1 - 2和1 - 3的触点分别在83%和94%的病例中与临床触点相符。临床使用的和预测的电极触点对应的手部震颤和手部功能平均改善率分别为79±21%和77±22%。
对于接受cZi DBS治疗ET的患者，可基于PSM预测有效电极触点。未来，这些预测可能用于减少在确定满意的刺激设置之前进行的临床评估次数。
