Pathway targeted deep brain stimulation for Parkinson's disease

帕金森病的靶向深部脑刺激途径

• 批准号: 8724575
• 负责人: NOAM HAREL
• 金额: $ 70.36万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8724575
• 关键词: Action Potentials; Adverse effects; Algorithms; Anatomic Models; Atlases; Axon; Basic Science; Behavior; Brain region; Clinical; Clinical Research; Clinical assessments; Cognitive; Computer Simulation; Coupled; Data; Deep Brain Stimulation; Diffusion weighted imaging; Electrodes; Elements; Equilibrium; Evaluation; Evolution; Generations; Globus Pallidus; Goals; Image; Imagery; Imaging Techniques; Implant; Investigation; Lead; Link; Location; Magnetic Resonance Imaging; Maps; Mediating; Modeling; Moods; Motor; Neural Pathways; Neurons; Neuropsychological Tests; Operative Surgical Procedures; Outcome; Outcome Measure; Output; Parkinson Disease; Pathway interactions; Patients; Predisposition; Probability; Process; Quality of life; Relative (related person); Research Subjects; Resolution; Rodent; Scheme; Stimulus; Structure of subthalamic nucleus; Symptoms; System; Technology; Therapeutic; clinical effect; clinical practice; cohort; effective therapy; electric field; image registration; implantation; improved; neuroimaging; prospective; public health relevance; research clinical testing; tool

DESCRIPTION (provided by applicant): Subthalamic deep brain stimulation (DBS) is an effective for the treatment of Parkinson's disease (PD). However, little is known about the specific neural pathway(s) responsible for therapeutic benefit. Direct stimulation of either the hyperdirect pathway and/or the subthalamopallidal pathway represents two of the most likely candidates as the "target". Therefore, the goal of this project is to combine patient-specific 7T imaging and neurostimulation models together to enable probabilistic identification of the stimulation pathways linked to changes in clinical outcome measures recorded from subthalamic DBS patients. This study will rely on tractography-activation models (TAMs) to guide clinical testing on a cohort of 30 subthalamic DBS patients. Our multi-disciplinary approach will integrate the latest advances in neuroimaging, neurostimulation modeling, and quantitative clinical outcome measures to customize DBS to these patients. The first aim will acquire high- resolution 7T MRI data prior to their implant surgery. These images will provide unparalleled anatomical characterization of each patient. The second aim will create patient-specific TAMs for each subject. These models will enable us to define theoretically optimal settings for focused activation of either the hyperdirect pathway or the subthalamopallidal pathway. The third aim will quantify the clinical outcomes achieved with stimulation parameters defined by either the TAM or traditional clinical practice. These clinical results will be coupled with the TAM predictions to create a probabilistic tractography-activation atlas (PTAA) for the subthalamic region. The results of this study will help identify optimal implantation locations for DBS electrodes, and enable theoretical prediction of stimulation parameter settings that focus activation on the targeted pathways and/or avoid side-effect pathways.

描述（由申请人提供）：丘脑下深脑刺激（DBS）可有效治疗帕金森氏病（PD）。但是，对负责治疗益处的特定神经途径知之甚少。直接刺激超直导途径和/或丘脑副途径代表两个最有可能的候选者作为“目标”。因此，该项目的目的是将特异性的7T成像和神经刺激模型组合在一起，以使概率鉴定刺激途径，这些刺激途径与丘脑下DBS患者记录的临床结局变化有关。这项研究将依靠拖拉学激活模型（TAM）来指导30名丘脑DBS患者的队列中的临床测试。我们的多学科方法将整合神经影像，神经刺激建模和定量临床结果指标的最新进展，以对这些患者自定义DBS。第一个目标将在植入手术之前获取高分辨率7T MRI数据。这些图像将为每个患者提供无与伦比的解剖表征。第二个目标将为每个受试者创建特定于患者的TAM。这些模型将使我们能够定义理论上最佳的设置，以侧重激活超直径途径或亚thalamopallidal途径。第三个目标将用TAM或传统临床实践定义的刺激参数来量化临床结果。这些临床结果将与TAM预测相结合，以创建丘脑下区域的概率拖拉学亚图集（PTAA）。这项研究的结果将有助于确定最佳植入地点 DBS电极，并启用刺激参数设置的理论预测，这些刺激参数设置将激活聚焦于靶向途径和/或避免副作用途径。