E H Middlebrooks1, I S Tuna2, S S Grewal3, L Almeida4, M G Heckman5, E R Lesser5, K D Foote6, M S Okun4, V M Holanda7. 1. From the Departments of Radiology (E.H.M.) Middlebrooks.Erik@mayo.edu. 2. Departments of Radiology (I.S.T.). 3. Neurosurgery (S.S.G.). 4. Neurology (L.A., M.S.O.). 5. Division of Biomedical Statistics and Informatics (M.G.H., E.R.L.), Mayo Clinic, Jacksonville, Florida. 6. Neurosurgery (K.D.F.), University of Florida, Gainesville, Florida. 7. Center of Neurology and Neurosurgery Associates (V.M.H.), BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND AND PURPOSE: Although globus pallidus internus deep brain stimulation is a widely accepted treatment for Parkinson disease, there is persistent variability in outcomes that is not yet fully understood. In this pilot study, we aimed to investigate the potential role of globus pallidus internus segmentation using probabilistic tractography as a supplement to traditional targeting methods. MATERIALS AND METHODS: Eleven patients undergoing globus pallidus internus deep brain stimulation were included in this retrospective analysis. Using multidirection diffusion-weighted MR imaging, we performed probabilistic tractography at all individual globus pallidus internus voxels. Each globus pallidus internus voxel was then assigned to the 1 ROI with the greatest number of propagated paths. On the basis of deep brain stimulation programming settings, the volume of tissue activated was generated for each patient using a finite element method solution. For each patient, the volume of tissue activated within each of the 10 segmented globus pallidus internus regions was calculated and examined for association with a change in the Unified Parkinson Disease Rating Scale, Part III score before and after treatment. RESULTS: Increasing volume of tissue activated was most strongly correlated with a change in the Unified Parkinson Disease Rating Scale, Part III score for the primary motor region (Spearman r = 0.74, P = .010), followed by the supplementary motor area/premotor cortex (Spearman r = 0.47, P = .15). CONCLUSIONS: In this pilot study, we assessed a novel method of segmentation of the globus pallidus internus based on probabilistic tractography as a supplement to traditional targeting methods. Our results suggest that our method may be an independent predictor of deep brain stimulation outcome, and evaluation of a larger cohort or prospective study is warranted to validate these findings.
BACKGROUND AND PURPOSE: Although globus pallidus internus deep brain stimulation is a widely accepted treatment for Parkinson disease, there is persistent variability in outcomes that is not yet fully understood. In this pilot study, we aimed to investigate the potential role of globus pallidus internus segmentation using probabilistic tractography as a supplement to traditional targeting methods. MATERIALS AND METHODS: Eleven patients undergoing globus pallidus internus deep brain stimulation were included in this retrospective analysis. Using multidirection diffusion-weighted MR imaging, we performed probabilistic tractography at all individual globus pallidus internus voxels. Each globus pallidus internus voxel was then assigned to the 1 ROI with the greatest number of propagated paths. On the basis of deep brain stimulation programming settings, the volume of tissue activated was generated for each patient using a finite element method solution. For each patient, the volume of tissue activated within each of the 10 segmented globus pallidus internus regions was calculated and examined for association with a change in the Unified Parkinson Disease Rating Scale, Part III score before and after treatment. RESULTS: Increasing volume of tissue activated was most strongly correlated with a change in the Unified Parkinson Disease Rating Scale, Part III score for the primary motor region (Spearman r = 0.74, P = .010), followed by the supplementary motor area/premotor cortex (Spearman r = 0.47, P = .15). CONCLUSIONS: In this pilot study, we assessed a novel method of segmentation of the globus pallidus internus based on probabilistic tractography as a supplement to traditional targeting methods. Our results suggest that our method may be an independent predictor of deep brain stimulation outcome, and evaluation of a larger cohort or prospective study is warranted to validate these findings.
Authors: E H Middlebrooks; R A Domingo; T Vivas-Buitrago; L Okromelidze; T Tsuboi; J K Wong; R S Eisinger; L Almeida; M R Burns; A Horn; R J Uitti; R E Wharen; V M Holanda; S S Grewal Journal: AJNR Am J Neuroradiol Date: 2020-08-13 Impact factor: 3.825
Authors: L Okromelidze; T Tsuboi; R S Eisinger; M R Burns; M Charbel; M Rana; S S Grewal; C-Q Lu; L Almeida; K D Foote; M S Okun; E H Middlebrooks Journal: AJNR Am J Neuroradiol Date: 2020-02-13 Impact factor: 3.825
Authors: Andreas Horn; Ningfei Li; Till A Dembek; Ari Kappel; Chadwick Boulay; Siobhan Ewert; Anna Tietze; Andreas Husch; Thushara Perera; Wolf-Julian Neumann; Marco Reisert; Hang Si; Robert Oostenveld; Christopher Rorden; Fang-Cheng Yeh; Qianqian Fang; Todd M Herrington; Johannes Vorwerk; Andrea A Kühn Journal: Neuroimage Date: 2018-09-01 Impact factor: 6.556
Authors: Joshua K Wong; Erik H Middlebrooks; Sanjeet S Grewal; Leonardo Almeida; Christopher W Hess; Michael S Okun Journal: Mov Disord Date: 2020-04-12 Impact factor: 10.338
Authors: Ahmad Elkouzi; Takashi Tsuboi; Matthew R Burns; Robert S Eisinger; Amar Patel; Wissam Deeb Journal: Tremor Other Hyperkinet Mov (N Y) Date: 2019-09-06
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Authors: Ka Loong Kelvin Au; Joshua K Wong; Takashi Tsuboi; Robert S Eisinger; Kathryn Moore; Janine Lemos Melo Lobo Jofili Lopes; Marshall T Holland; Vanessa M Holanda; Zhongxing Peng-Chen; Addie Patterson; Kelly D Foote; Adolfo Ramirez-Zamora; Michael S Okun; Leonardo Almeida Journal: Neurol Ther Date: 2020-11-02