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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Probabilistic mapping of antidystonic effect of pallidal neurostimulation – multicentre imaging study

Probabilistische Kartierung der antidystonen Wirkung pallidaler Neurostimulation – eine multicentre Bildgebungs-Studie

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  • presenting/speaker Martin Reich - Universitätsklinik Würzburg, Neurologische Klinik, Würzburg, Deutschland
  • Andreas Horn - Charité – Universitätsmedizin Berlin, Neurologie, Berlin, Deutschland
  • Florian Lange - Universitätsklinik Würzburg, Neurologische Klinik, Würzburg, Deutschland
  • Jonas Roothans - Universitätsklinik Würzburg, Neurologische Klinik, Würzburg, Deutschland
  • Steffen Paschen - UKSH Kiel, Neurologie, Kiel, Deutschland
  • Joachim Runge - MHH Hannover, Neurochirurgische Klinik, Hannover, Deutschland
  • Robert Nickl - Universitätsklinik Würzburg, Neurochirurgische Klinik, Würzburg, Deutschland
  • Gerd-Helge Schneider - Charité – Universitätsmedizin Berlin, Neurochirurgische Klinik, Berlin, Deutschland
  • Volker Coenen - Universität Freiburg, Klinik für Stereotaxie und Funktionelle Neurochirurgie, Freiburg, Deutschland
  • Wilhelm Eisner - Universität Innsbruck, Neurochirurgische Klinik, Innsbruck, Austria
  • Ann-Kristin Helmers - UKSH Kiel, Neurochirurgische Klinik, Kiel, Deutschland
  • Cordula Matthies - Universitätsklinik Würzburg, Neurochirurgische Klinik, Würzburg, Deutschland
  • Volker Sturm - Universitätsklinik Würzburg, Neurochirurgische Klinik, Würzburg, Deutschland
  • Joachim K. Krauss - MHH Hannover, Neurochirurgische Klinik, Hannover, Deutschland
  • Andrea Kühn - Charité – Universitätsmedizin Berlin, Neurologie, Berlin, Deutschland
  • Günther Deuschl - UKSH Kiel, Neurologie, Kiel, Deutschland
  • Jens Volkmann - Universitätsklinik Würzburg, Neurologische Klinik, Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV234

doi: 10.3205/19dgnc253, urn:nbn:de:0183-19dgnc2537

Published: May 8, 2019

© 2019 Reich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Deep brain stimulation of the internal globus pallidus is a highly effective and established therapy for primary generalized and cervical dystonia, but therapeutic success is compromised by a non-responder rate of up to 25%, even in carefully-selected groups. Variability in electrode placement and inappropriate stimulation settings may account for a large proportion of this outcome variability.

Methods: Here, we present probabilistic mapping data on a large cohort of patients collected from several European centres to resolve the optimal stimulation volume within the pallidal region. A total of 105 dystonia patients with pallidal deep brain stimulation were enrolled and 87 datasets (43 with cervical dystonia and 44 with generalized dystonia) were included into the subsequent “normative brain” analysis.

Results: The average improvement of dystonia motor score was 50.5±30.9% in cervical and 58.2±48.8% in generalized dystonia, while 19.5% of patients did not respond to treatment (<25% benefit). We defined a significant probabilistic volume of anti-dystonic effects by aggregating the individual volumes of tissue activated in normative atlas space and ranking voxel-wise for outcome distribution. The most beneficial stimulation volume was located within the posterior-ventral part of the GPi adjacent to subpallidal white matter and strongly predicted, also at a single subject level, the clinical efficacy of deep brain stimulation. Stimulation of this region was achieved by a variety of different electrode positions and stimulation settings.

Conclusion: Probabilistic outcome brain mapping is a promising tool to estimate the expected benefit, and it advances computer-assisted planning and programming of deep brain stimulation.