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Deep brain stimulation (DBS) is an important therapy for movement disorders such as Parkinson’s disease and essential tremor, and DBS is expanding towards psychiatric illness e.g. Tourette syndrome. In this project we aim at bringing together multiparametric DBS data for clinical support i.e. to go from “mental imagination” to “intuitive visualization” in the surgical planning and follow up of DBS. The work proceeds in parallel but interactive work packages with partners from an international multidisciplinary team with abroad expertise in both technical and clinical DBS-research.
Professor Simone Hemm-Ode
Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Art Northwestern Switzerland (FHNW), CH and Guest Researcher at Linköping University.
Professor Marwan Hariz
Past chair of Functional Neurosurgery, Institute of Neurology, University College London, UK, Adjunct Prof. DBS Unit, Norrland Univ. Hospital, Umeå
Dr. Peter Zsigmond
Consultant Neurosurgeon, Dept. of Neurosurgery, Linköping University Hospital, Sweden
Deep brain stimulation
Deep brain stimulation (DBS) is an important therapy for movement disorders such as Parkinson’s disease and essential tremor, and DBS is expanding towards psychiatric illness e.g. Tourette syndrome (Hariz et al., 2013). Four contacts DBS leads are the most commonly implanted, but DBS leads which can steer the field are other options recently introduced.
Stereotactic DBS implantation and imaging
Stereotactic MRI is used for pre-operative target identification and planning of trajectories. During surgery the DBS electrode is introduced to the target point and the operation is fulfilled. Intraoperative measurements of neuronal activity with microelectrode recording (MER), microvascular blood flow with laser Doppler flowmetry (LDF), or movement with wrist accelerometers may be done in relation to surgery. Post-operative verification of the DBS lead position is accomplished using MRI or CT (Hemm and Wårdell, 2010).
Patient-specific electric field simulations
Finite element method (FEM) simulation of the electric field surrounding the DBS lead is done in COMSOL Multiphysics. Individual DBS settings together with the pre- and postoperative images makes it patient-specific. Brain models are built in MatLab. Prerpogrammed COMSOL-Apps for DBS lead configurations and stimulations modes will be designed. Results are visualized with the patient own preoperative images (Åström et al., 2009, Alonso et al., 2016).
By using diffusion MRI (dMRI) different white matter tracts connecting brain regions involved in DBS will be anatomically visualized and combined with the patient-specific electric field simulations. The dentato-rubro-thalamo-cortical circuit is important for DBS in the Vim and Zi (Pujol et al., 2017). Other white fiber tract of interest are the pallidothalamic tracts and the hyperdirect cortico-subthalamic tracts.
Intraoperative accelerometer measurement of movement
Intraoperative optical measurements of blood flow and tissue type
Brain atlas mapping
Alonso F, Models and Simulations of the Electric Field in Deep Brain Stimulation: Comparison of Lead Designs, Operating Modes and Tissue Conductivity, Linköping Studies in Science and Technology.Dissertation No. 1945, 2018
Latorre M, The Physical Axon: Modeling, Simulation and Electrode Evaluation, Linköping Studies in Science and Technology.Dissertation No. 1847, 2017
Johansson D, Alonso F, Wårdell K,Patient-Specific Simulations of Deep Brain Stimulation Electric Field with Aid of In-house Software ELMA, Accepted, IEEE-EMBC, pp 1-5, 2019
Wårdell K, Hemm-Ode S, Zsigmond P, A System for Combined Laser Doppler Flowmetry and Microelectrode Recording during Deep Brain Stimulation Implantation, Accepted, IEEE-EMBC, pp 1-4, 2019
Latorre M and Wårdell K, A Comparison between Single and Double Cable Neuron Models Applicable to Deep Brain Stimulation, Biomedical Physics & Engineering Express, 5(2),1-13, 2019
Shah AA, Alonso F, Vogel D, Wårdell K, Coste J, Lemaire JJ, Pison D, Hemm S. Analysis of adverse effects of stimulation during DBS surgery by patient-specific FEM simulations. Conf Proc IEEE Eng Med Biol Soc. 2018 Jul;2018:2222-2225.
Johansson JD, Alonso F, Wårdell K, Modelling Details for Electric Field Simulations of Deep Brain Stimulation. In: Lhotska L, Sukupova L, Lackovic I, Ibbott G (eds). IFMBE Proceedings Springer, pp 645-648, vol 68/1, 2018.
Alonso F., Vogel D., Johansson J., Wårdell K, Hemm-Ode S. Electric Field Comparison between Microelectrode Recording and Deep Brain Stimulation Systems-A Simulation Study , Brain Sci., 8(2), 2018
Zsigmond P., Hemm-Ode S., Wårdell K. Optical Measurements during Deep Brain Stimulation Lead Implantation: Safety Aspects , Stereotact Funct Neurosurg., 95(6):392-399, 2018
Akbarian-Tefaghi L, Johansson J, Harith A, Eileen J, Limousin P, Zrinzo L, Hariz M, Wårdell K, Foltynie T, Refining the Deep Brain Stimulation target within the Limbic Globus Pallidus internus for Tourette syndrome, Stereotactic and Functional Neurosurgery, Vol. 95, nr 4, pp 251-258, 2017
Hemm S, Pison D, Alonso F, Shah A, Coste J, Lemaire JJ, Wårdell K.
Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus. Front Hum Neurosci. 2016 Nov 25;10:577.
Alonso F, Latorre MA, Göransson N, Zsigmond P, Wårdell K. Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study. Brain Sci. 2016 Sep 7;6(3).
Johansson J, Akbarian-Tefaghi L, Harith A, Zrinzo L, Limousin P, Eileen J Hariz M, Wårdell K, Foltynie T, Estimation of effective target area in the globus pallidus during deep brain stimulation for Tourette syndrome. World Society for Stereotactic and Functional Neurosurgery, 17th Quadrennial meeting, Berlin June 26-29, 2017 (Oral)
Wårdell K, Fibre based optical techniques for guidance during stereotactic neurosurgery – a review. World Society for Stereotactic and Functional Neurosurgery, 17thQuadrennial meeting, Berlin June 26-29, 2017 (Oral)
Shah A, Alonso F, Lemaire JJ, Pison D, Coste J, Wårdell K. Schkommodau E, Hemm-Ode SLearning more about the optimal anatomical position for deep brain stimulation in essential tremor patients: 3D visualisation of intraoperative stimulation test results. World Society for Stereotactic and Functional Neurosurgery, 17th Quadrennial meeting, Berlin June 26-29, 2017 (Poster)
Wårdell K, Johansson J, Alonso F, Deep brain stimulation: software for patient-specific electric field simulations, World Society for Stereotactic and Functional Neurosurgery, 17th Quadrennial meeting, Berlin June 26-29, 2017 (Poster)
Alonso F, Vogel D, Wårdell K, Hemm S, Comparison between intraoperative and chronic and deep brain stimulation. World Society for Stereotactic and Functional Neurosurgery, 17th Quadrennial meeting, Berlin June 26-29, 2017 (Poster)
Göransson N, Johansson J, Alonso F, Wårdell K, Zsigmond P, Postoperative lead movement after deep brain stimulation surgery and changes of stimulation area. World Society for Stereotactic and Functional Neurosurgery, 17th Quadrennial meeting, Berlin June 26-29, 2017 (Poster)