Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, Muttenz, Switzerland.
Department of Biomedical Engineering, Linköping University, Campus US, Linköping, Sweden.
J Neural Eng. 2024 May 17;21(3). doi: 10.1088/1741-2552/ad4742.
Deep brain stimulation (DBS) is a therapy for Parkinson's disease (PD) and essential tremor (ET). The mechanism of action of DBS is still incompletely understood. Retrospective group analysis of intra-operative data recorded from ET patients implanted in the ventral intermediate nucleus of the thalamus (Vim) is rare. Intra-operative stimulation tests generate rich data and their use in group analysis has not yet been explored.To implement, evaluate, and apply a group analysis workflow to generate probabilistic stimulation maps (PSMs) using intra-operative stimulation data from ET patients implanted in Vim.A group-specific anatomical template was constructed based on the magnetic resonance imaging scans of 6 ET patients and 13 PD patients. Intra-operative test data (total:= 1821) from the 6 ET patients was analyzed: patient-specific electric field simulations together with tremor assessments obtained by a wrist-based acceleration sensor were transferred to this template. Occurrence and weighted mean maps were generated. Voxels associated with symptomatic response were identified through a linear mixed model approach to form a PSM. Improvements predicted by the PSM were compared to those clinically assessed. Finally, the PSM clusters were compared to those obtained in a multicenter study using data from chronic stimulation effects in ET.Regions responsible for improvement identified on the PSM were in the posterior sub-thalamic area (PSA) and at the border between the Vim and ventro-oral nucleus of the thalamus (VO). The comparison with literature revealed a center-to-center distance of less than 5 mm and an overlap score (Dice) of 0.4 between the significant clusters. Our workflow and intra-operative test data from 6 ET-Vim patients identified effective stimulation areas in PSA and around Vim and VO, affirming existing medical literature.This study supports the potential of probabilistic analysis of intra-operative stimulation test data to reveal DBS's action mechanisms and to assist surgical planning.
深部脑刺激（DBS）是治疗帕金森病（PD）和原发性震颤（ET）的一种方法。DBS 的作用机制尚不完全清楚。对植入丘脑腹中间核（Vim）的 ET 患者进行术中数据的回顾性分组分析很少见。术中刺激测试产生了丰富的数据，但其在分组分析中的应用尚未得到探索。实施、评估和应用分组分析工作流程，使用植入 Vim 的 ET 患者的术中刺激数据生成概率刺激图（PSM）。根据 6 名 ET 患者和 13 名 PD 患者的磁共振成像扫描构建了一个组特异性解剖模板。对 6 名 ET 患者的术中测试数据（总计：1821）进行了分析：将患者特异性电场模拟与腕部加速度传感器获得的震颤评估一起传输到该模板。生成出现和加权均值图。通过线性混合模型方法识别与症状反应相关的体素，以形成 PSM。通过 PSM 预测的改善与临床评估的改善进行比较。最后，将 PSM 簇与使用 ET 慢性刺激效果数据的多中心研究中获得的簇进行比较。PSM 上确定的与改善相关的区域位于后丘脑下区（PSA）和 Vim 与丘脑腹侧口核（VO）之间的边界处。与文献的比较显示，显著簇之间的中心到中心距离小于 5 毫米，重叠分数（Dice）为 0.4。我们的工作流程和来自 6 名 ET-Vim 患者的术中测试数据确定了 PSA 和 Vim 周围以及 VO 中有效的刺激区域，证实了现有医学文献。这项研究支持对术中刺激测试数据进行概率分析以揭示 DBS 的作用机制并辅助手术计划的潜力。
