2022-04-11, Wårdell, Karin, Nordin, Teresa, Zsigmond, Peter, Westin, Carl-Fredrik, Hariz, Marwan, Vogel, Dorian, Hemm-Ode, Simone

Deep brain stimulation (DBS) is a well-established neurosurgical procedure for movement disorders that is also being explored for treatment-resistant psychiatric conditions. This review highlights important consideration for DBS simulation and data analysis. The literature on DBS has expanded considerably in recent years, and this article aims to identify important trends in the field. During DBS planning, surgery, and follow up sessions, several large data sets are created for each patient, and it becomes clear that any group analysis of such data is a big data analysis problem and has to be handled with care. The aim of this review is to provide an update and overview from a neuroengineering perspective of the current DBS techniques, technical aids, and emerging tools with the focus on patient-specific electric field (EF) simulations, group analysis, and visualization in the DBS domain. Examples are given from the state-of-the-art literature including our own research. This work reviews different analysis methods for EF simulations, tractography, deep brain anatomical templates, and group analysis. Our analysis highlights that group analysis in DBS is a complex multi-level problem and selected parameters will highly influence the result. DBS analysis can only provide clinically relevant information if the EF simulations, tractography results, and derived brain atlases are based on as much patient-specific data as possible. A trend in DBS research is creation of more advanced and intuitive visualization of the complex analysis results suitable for the clinical environment.

2021-04, Quirin, Thomas, Féry, Corentin, Vogel, Dorian, Vergne, Céline, Sarracanie, Mathieu, Salameh, Najat, Madec, Morgan, Hemm-Ode, Simone, Hébrard, Luc, Pascal, Joris

This paper presents a tracking system using magnetometers, possibly integrable in a deep brain stimulation (DBS) electrode. DBS is a treatment for movement disorders where the position of the implant is of prime importance. Positioning challenges during the surgery could be addressed thanks to a magnetic tracking. The system proposed in this paper, complementary to existing procedures, has been designed to bridge preoperative clinical imaging with DBS surgery, allowing the surgeon to increase his/her control on the implantation trajectory. Here the magnetic source required for tracking consists of three coils, and is experimentally mapped. This mapping has been performed with an in-house three-dimensional magnetic camera. The system demonstrates how magnetometers integrated directly at the tip of a DBS electrode, might improve treatment by monitoring the position during and after the surgery. The three-dimensional operation without line of sight has been demonstrated using a reference obtained with magnetic resonance imaging (MRI) of a simplified brain model. We observed experimentally a mean absolute error of 1.35 mm and an Euclidean error of 3.07 mm. Several areas of improvement to target errors below 1 mm are also discussed.

2020-04-25, Vogel, Dorian, Shah, Ashesh, Hemm-Ode, Simone

Deep brain stimulation (DBS) therapy requires extensive patient-specific planning prior to implantation to achieve optimal clinical outcomes. Collective analysis of patient’s brain images is promising in order to provide more systematic planning assistance. In this paper the design of a normalization pipeline using a group specific multi-modality iterative template creation process is presented. The focus was to compare the performance of a selection of freely available registration tools and select the best combination. The workflow was applied on 19 DBS patients with T1 and WAIR modality images available. Non-linear registrations were computed with ANTS, FNIRT and DRAMMS, using several settings from the literature. Registration accuracy was measured using single-expert labels of thalamic and subthalamic structures and their agreement across the group. The best performance was provided by ANTS using the High Variance settings published elsewhere. Neither FNIRT nor DRAMMS reached the level of performance of ANTS. The resulting normalized definition of anatomical structures were used to propose an atlas of the diencephalon region defining 58 structures using data from 19 patients.

2022, Nordin, Teresa, Vogel, Dorian, Osterlund, Erik, Johansson, Johannes, Fytagoridis, Anders, Blomstedt, Patric, Hemm-Ode, Simone, Wardell, Karin

Background Group analysis of patients with deep brain stimulation (DBS) has the potential to help understand and optimize the treatment of patients with movement disorders. Probabilistic stimulation maps (PSM) are commonly used to analyze the correlation between tissue stimulation and symptomatic effect but are applied with different methodological variations. Objective To compute a group-specific MRI template and PSMs for investigating the impact of PSM model parameters. Methods Improvement and occurrence of dizziness in 68 essential tremor patients implanted in caudal zona incerta were analyzed. The input data includes the best parameters for each electrode contact (screening), and the clinically used settings. Patient-specific electric field simulations (n = 488) were computed for all DBS settings. The electric fields were transformed to a group-specific MRI template for analysis and visualization. The different comparisons were based on PSMs representing occurrence (N-map), mean improvement (M-map), weighted mean improvement (wM-map), and voxel-wise t-statistics (p-map). These maps were used to investigate the impact from input data (clinical/screening settings), clustering methods, sampling resolution, and weighting function. Results Screening or clinical settings showed the largest impacts on the PSMs. The average differences of wM-maps were 12.4 and 18.2% points for the left and right sides respectively. Extracting clusters based on wM-map or p-map showed notable variation in volumes, while positioning was similar. The impact on the PSMs was small from weighting functions, except for a clear shift in the positioning of the wM-map clusters. Conclusion The distribution of the input data and the clustering method are most important to consider when creating PSMs for studying the relationship between anatomy and DBS outcome.

2021, Vergne, Céline, Madec, Morgan, Hemm-Ode, Simone, Quirin, Thomas, Vogel, Dorian, Hebrard, Luc, Pascal, Joris

This paper proposes a three-dimensional (3D) orientation tracking method of a 3D magnetic sensor embedded in a 2.5 mm diameter electrode. Our system aims to be used during intraoperative surgery to detect the orientation of directional leads (D-leads) for deep brain stimulation (DBS).

2020-01-30, Shah, Ashesh, Vogel, Dorian, Pison, Daniela, Schkommodau, Erik, Hemm-Ode, Simone

2021-04-10, Quirin, Thomas, Féry, Corentin, Vogel, Dorian, Vergne, Céline, Sarracanie, Mathieu, Salameh, Najat, Madec, Morgan, Hemm-Ode, Simone, Hebrard, Luc, Pascal, Joris

This paper presents a tracking system using magnetometers, possibly integrable in a deep brain stimulation (DBS) electrode. DBS is a treatment for movement disorders where the position of the implant is of prime importance. Positioning challenges during the surgery could be addressed thanks to a magnetic tracking. The system proposed in this paper, complementary to existing procedures, has been designed to bridge preoperative clinical imaging with DBS surgery, allowing the surgeon to increase his/her control on the implantation trajectory. Here the magnetic source required for tracking consists of three coils, and is experimentally mapped. This mapping has been performed with an in-house three-dimensional magnetic camera. The system demonstrates how magnetometers integrated directly at the tip of a DBS electrode, might improve treatment by monitoring the position during and after the surgery. The three-dimensional operation without line of sight has been demonstrated using a reference obtained with magnetic resonance imaging (MRI) of a simplified brain model. We observed experimentally a mean absolute error of 1.35 mm and an Euclidean error of 3.07 mm. Several areas of improvement to target errors below 1 mm are also discussed.

2020-11-30, Vogel, Dorian, Wardell, Karin, Coste, Jérôme, Lemaire, Jean-Jaques, Hemm-Ode, Simone, Jarm, Tomaz, Cvetkoska, Aleksandra, Mahnič-Kalamiza, Samo, Miklavcic, Damijan

Abstract : Electrical stimulation of the deep parts of the brain is the standard answer for patients subject to drug-refractory movement disorders. Collective analysis of data collected during surgeries are crucial in order to provide more systematic planning assistance and understanding the physiological mechanisms of action. To that end, the process of normalizing anatomies captured with Magnetic Resonance imaging across patients is a key component. In this work, we present the optimization of a workflow designed to create group-specific anatomical templates: a group template is refined iteratively using the results of successive non-linear image registrations with refinement steps in the in the basal-ganglia area. All non-linear registrations were executed using the Advanced Normalization Tools (ANTs) and the quality of the nor-malization was measured using spacial overlap of anatomical structures manually delineated during the planning of the surgery. The parameters of the workflow evaluated were: the use of multiple modalities sequentially or together during each registration to the template, the number of iterations in the template creation and the fine settings of the non-linear registration tool. Using the T1 and white matter attenuated inverse recovery modalities (WAIR) together produced the best results, especially in the center of the brain. The optimal numbers of iterations of the template creation were higher than those from the literature and our previous works. Finally, the setting of the non-linear registration tool that improved results the most was the activation of the registration with the native voxel sizes of images, as opposed to down-sampled version of the images. The normalization process was optimized over our previous study and allowed to obtain the best possible anatomical nor-malization of this specific group of patient. It will be used to summarize and analyze peri-operative measurements during test stimulation. The aim is that the conclusions obtained from this analysis will be useful for assistance during the planning of new surgeries.