Patient-Specific Models of Deep Brain Stimulation

深部脑刺激的患者特异性模型

• 批准号: 6966993
• 负责人: Cameron McIntyre
• 金额: $ 21.23万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-15 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6966993
• 关键词: Parkinson' s disease; biological models; clinical biomedical equipment; clinical research; computer program /software; diffusion magnetic resonance imaging; dystonia; electric field; electrical property; electrodes; electrostimulus; epilepsy; health care model; human subject; human therapy evaluation; mathematical model; model design /development; nervous system disorder therapy; obsessive compulsive disorder; patient oriented research; technology /technique development; therapy design /development; three dimensional imaging /topography; transcranial magnetic stimulation; tremor

DESCRIPTION (provided by applicant): Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has rapidly emerged as an effective treatment in medically refractory Parkinson's disease (PD). However, our understanding of the effects of DBS is limited and as a result programming DBS devices for optimal clinical benefit is a difficult and time consuming process. The central hypothesis of the planned work is that patient-specific models of DBS can predict a theoretically optimal stimulation parameter setting that will provide therapeutic benefit equal to that achieved by current trial-and-error programming strategies. The fundamental concept behind this project is that if clinicians had tools that enabled visualization of the anatomical and electrical effects of DBS they would be able to quickly and accurately adjust the stimulation for maximal therapeutic benefit. Previous work of the principal investigator and his collaborators has provided the core scientific components necessary to realize such a tool. However, no quantitative measures of the size and shape of the 3D volume of tissue activated by DBS currently exist within the clinical arena. Therefore, we propose the development of patient-specific models of STN DBS based on anatomical and diffusion tensor magnetic resonance imaging (MRI). We will use these models to establish correlations between electrode locations / stimulation parameters / volumes of activation and therapeutic benefit as determined from clinical evaluation of individual patients. We will then use the models to define theoretically optimal stimulation parameter settings custom to the individual. The therapeutic efficacy of the model-designed settings will then be compared to the settings determined by current clinical practice. If our hypothesis is supported, we believe the technology and software developed in this study could significantly decrease the time and effort necessary to program DBS devices, and be applicable to a wide range of clinical applications including PD, essential tremor, dystonia, epilepsy, and obsessive-compulsive disorder.

描述（由申请人提供）：丘脑下核（STN）的深脑刺激（DB）已迅速作为医学难治性帕金森氏病（PD）的有效治疗方法。但是，我们对DBS效应的理解是有限的，因此编程DBS设备以获得最佳临床益处是一个困难且耗时的过程。计划工作的中心假设是，特定于患者的DBS模型可以预测理论上最佳的刺激参数设置，该设置将提供与当前试用和错误编程策略相当的治疗益处。该项目背后的基本概念是，如果临床医生拥有能够可视化DBS的解剖和电效应的工具，他们将能够快速，准确地调整刺激以获得最大的治疗益处。首席调查员及其合作者的先前工作提供了实现这种工具所需的核心科学组成部分。但是，目前在临床领域内，目前存在着由DBS激活的3D组织的大小和形状的定量测量。因此，我们提出了基于解剖和扩散张量磁共振成像（MRI）的患者特异性STN DBS模型的发展。我们将使用这些模型在电极位置 /刺激参数 /体积激活和治疗益处之间建立相关性，并根据单个患者的临床评估确定。然后，我们将使用模型来定义为个人定义自定义的理论上最佳刺激参数设置。然后将将模型设计设置的治疗功效与当前临床实践确定的设置进行比较。如果支持我们的假设，我们认为这项研究中开发的技术和软件可以大大减少编程DBS设备所需的时间和精力，并适用于广泛的临床应用，包括PD，Essential Tremor，dystonia，Dystonia，癫痫，癫痫和强迫症。