Probabilistic mapping of deep brain stimulation in childhood dystonia. (December 2022)

• Record Type: Journal Article
• Authors: Lumsden, Daniel E.; Tambirajoo, Kantharuby; Hasegawa, Harutomo; Gimeno, Hortensia; Kaminska, Margaret; Ashkan, Keyoumars; Selway, Richard; Lin, Jean-Pierre
• Is Part Of: Parkinsonism & related disorders. Volume 105(2022)
• Page Start: 103
• Page End: 110
• Publication Date: 2022-12
• Subjects: Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2022.11.006
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Objectives: In adults with dystonia Probabilistic Stimulation Mapping (PSM) has identified putative "sweet spots" for stimulation. We aimed to apply PSM to a cohort of Children and Young People (CYP) following DBS surgery. Methods: Pre-operative MRI and post-operative CT images were co-registered for 52 CYP undergoing bilateral pallidal DBS (n = 31 genetic/idiopathic dystonia, and n = 21 Cerebral Palsy (CP)). DBS electrodes (n = 104) were automatically detected, and Volumes of Tissue Activation (VTA) derived from individual patient stimulation settings. VTAs were normalised to the MNI105 space, weighted by percentage improvement in Burke-Fahn-Marsden Dystonia Rating scale (BFMDRS) at one-year post surgery and mean improvement was calculated for each voxel. Results: For the genetic/idiopathic dystonia group, BFMDRS improvement was associated with stimulation across a broad volume of the GPi. A spatial clustering of the upper 25th percentile of voxels corresponded with a more delineated volume within the posterior ventrolateral GPi. The MNI coordinates of the centroid of this volume (X = −23.0, Y = −10.5 and Z = −3.5) were posterior and superior to the typical target for electrode placement. Volume of VTA overlap with a previously published "sweet spots" correlated with improvement following surgery. In contrast, there was minimal BFMDRS improvement for the CP group, no spatial clustering of efficacious clusters and a correlation between established "sweet spots" could not be established. Conclusions: PSM in CYP with genetic/idiopathic dystonia suggests the presence of a "sweet spot" for electrode placement within the GPi, consistent with previous studies. Further work is required to identify and validate putative "sweet spots" across different cohorts of patients. Highlights: We have applied Probabilistic stimulation mapping to a cohort of children following Deep Brain Stimulation of the GPi. For CYP with idiopathic/genetic dystonia, stimulation of a GPi sub-volume was associated with greater dystonia improvement. No such optimal volume for stimulation could be found for CYP with Cerebral Palsy.