The optimal pallidal target in deep brain stimulation for dystonia: a study using a functional atlas based on nonlinear image registration.

Tolleson C, Pallavaram S, Li C, Fang J, Phibbs F, Konrad P, Hedera P, D'Haese PF, Dawant BM, Davis TL
Stereotact Funct Neurosurg. 2015 93 (1): 17-24

PMID: 25502118 · PMCID: PMC4348210 · DOI:10.1159/000368441

BACKGROUND - 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.

METHODS - 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).

RESULTS - 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.

CONCLUSIONS - 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.

MeSH Terms (21)

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

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