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The Optimal Pallidal Target in Deep Brain Stimulation for Dystonia: A Study Using a Functional Atlas Based on Nonlinear Image Registration

Authors: Christopher, Tolleson; Srivatsan, Pallavaram; Chen, Li; John, Fang; Fenna, Phibbs; Peter, Konrad; Peter, Hedera; +3 Authors

The Optimal Pallidal Target in Deep Brain Stimulation for Dystonia: A Study Using a Functional Atlas Based on Nonlinear Image Registration

Abstract

<b><i>Background:</i></b> Deep brain stimulation (DBS) of the globus pallidus internus is established as efficacious for dystonia, yet the optimal target within this structure is not well defined. Published evidence suggests that spatial normalization provides a better estimate of DBS lead location than traditional methods based on standard stereotactic coordinates. <b><i>Methods:</i></b> We retrospectively reviewed our pallidal implanted dystonia population. Patient imaging scans were morphed into an MRI atlas using a nonlinear image registration algorithm. Active contact locations were projected onto the atlas and clusters analyzed for the degree of variance in two groups: (1) good and poor responders and (2) cervical (CD) and generalized dystonia (GD). <b><i>Results:</i></b> The average active contact location between CD and GD good responders was distinct but not significantly different. The mean active contact for CD poor responders was significantly different from CD responders and GD poor responders in the dorsoventral direction. <b><i>Conclusions:</i></b> A normalized imaging space is arguably more accurate in visualizing postoperative leads. Despite some separation between groups, this data suggests there was not an optimal pallidal target for common dystonia patients. Degrees of variance overlapped due to a large degree of individual target variation. Patient selection may ultimately be the key to maximizing patient outcomes. © 2014 S. Karger AG, Basel

Subjects by Vocabulary

Microsoft Academic Graph classification: medicine.medical_treatment Brain mapping Dystonia education.field_of_study Globus pallidus Radiology Psychology medicine.medical_specialty Deep brain stimulation Population Image registration Text mining medicine education business.industry medicine.disease Spatial normalization business Neuroscience

Keywords

Male, Deep Brain Stimulation, Multimodal Imaging, Severity of Illness Index, Child, Brain Mapping, Middle Aged, Magnetic Resonance Imaging, Treatment Outcome, Dystonic Disorders, Child, Preschool, Female, Adult, Adolescent, Globus Pallidus, Article, Young Adult, Atlases as Topic, Humans, Aged, Retrospective Studies, Surgery, Neurology (clinical), Tomography, X-Ray Computed

32 references, page 1 of 4

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2 Geyer HL, Bressman SB: The diagnosis of dystonia. Lancet Neurol 2006;5:780-790.

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4 Jankovic J: Re-emergence of surgery for dystonia. J Neurol Neurosurg Psychiatry 1998; 65:434.

5 Kiss ZH, Doig-Beyaert K, Eliasziw M, Tsui J, Haffenden A, Suchowersky O; Functional and Stereotactic Section of the Canadian Neurosurgical Society; Canadian Movement Disorders Group: The Canadian multicentre study of deep brain stimulation for cervical dystonia. Brain 2007;130:2879-2886. [OpenAIRE]

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7 Vasques X, Cif L, Gonzalez V, Nicholson C, Coubes P: Factors predicting improvement in primary generalized dystonia treated by pallidal deep brain stimulation. Mov Disord 2009;24:846-853.

8 Kupsch A, Bencke R, Muller J, Trottenberg T, Schneider GH, Poewe W, Eisner W, Wolters A, Müller JU, Deuschl G, Pinsker MO, Skogseid IM, Roeste GK, Vollmer-Haase J, Brentrup A, Krause M, Tronnier V, Schnitzler A, Voges J, Nikkhah G, Vesper J, Naumann M, Volkmann J; Deep-Brain Stimulation for Dystonia Study Group: Pallidal deep-brain stimulation of the globus pallidus in primary generalized or segmental dystonia. N Engl J Med 2006;355:1978-1990.

9 Hung SW, Hamani C, Lozano AM, Poon YY, Piboolnurak P, Miyasaki JM, Lang AE, Dostrovsky JO, Hutchison WD, Moro E: Long-term outcome of bilateral pallidal deep brain stimulation for primary cervical dystonia. Neurology 2007;68:457-459.

10 Starr PA, Turner RS, Rau G, Lindsey N, Heath S, Volz M, Ostrem JL, Marks WJ Jr: Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. Neurosurg Focus 2004;17:E4.

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    Top 10%
    influence
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    Top 10%
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
14
Top 10%
Average
Top 10%
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bronze