Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy

F. Schaper, Yan Zhao, L. Wagner, A. Colon, V. van Kranen-Mastenbroek, E. Gommer, M. Janssen, L. Ackermans, Richard Jack Anton van Wezel, Y. Temel, Tjitske Heida, R. Rouhl

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademic

Abstract

Introduction: Patients with medically refractory epilepsy treated with deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) vary highly in their therapy response. Proper positioning of the DBS lead is crucial to maximize efficacy and minimize side effects. For a correct implantation, the ANT is anatomically located using pre-operative 3T MRI and perioperative microelectrode recordings (MER). Neurons in the ANT have highly variable, yet characteristic patterns of firing in bursts. During DBS lead implantation, we noted differences among patients’ characteristic burst patterns along the electrode trajectory. In this study, we investigate whether electrophysiological characteristics of the target region could predict therapy response to DBS and could thus be used to improve ANT targeting during DBS surgery. Objectives: To determine whether perioperative neurophysiological characteristics relate to therapy response in DBS for patients with medically refractory epilepsy. Patients and methods: We included ten consecutive epilepsy patients planned for DBS surgery at Maastricht University Medical Center. All patients were diagnosed with medically refractory epilepsy and had incapacitating seizures. Patients failed trials of at least two reasonably tolerated and adequately chosen antiepileptic drug schedules. Using pre-operative 3T MRI, we planned an extraventricular approach to target. The ANT was defined as a grey matter structure at the top of the mamillothalamic tract. Along this trajectory, we performed stereotactic single cell MERs. The anatomical location of the recordings were verified using preoperative 3T MR images. We compared characteristics of the neural signals at different depths along the trajectory between DBS responders and non-responders. Responders were defined as patients with a seizure frequency reduction of more than 50% at one year follow-up. Results: Using MER data from 19 electrode trajectories of ten patients (one unilateral and nine bilateral trajectories), we found high-amplitude neuronal bursts around the target area or ANT. Responders to DBS (n = 5) had higher normalized mean firing rates and mean burst rates near the target area compared to nonresponders (n = 5), with a clearer delineation between the target region and surroundings. Electrode trajectories and lead localization did not differ between responders and non-responders. Conclusion: Single cell firing patterns in the ANT relate to therapy response in DBS for patients with medically refractory epilepsy. Analysis of single cell firing patterns using MER may guide targeting or contribute to predicting therapy response to ANT DBS. Further exploration into the use of electrophysiological recordings is warranted to improve targeting or predict outcome in DBS for epilepsy patients.
Original languageUndefined
Title of host publicationInternational Conference on Deep Brain Stimulation (DBS 2016)
Place of PublicationAmsterdam
PublisherElsevier
Pagese205-e206
Number of pages1
DOIs
Publication statusPublished - 2016

Publication series

NameClinical Neurophysiology
PublisherElsevier
Number9
Volume127
ISSN (Print)1388-2457
ISSN (Electronic)1872-8952

Keywords

  • BSS-Electrical Neurostimulation
  • IR-103187
  • METIS-321667
  • EWI-27535

Cite this

Schaper, F., Zhao, Y., Wagner, L., Colon, A., van Kranen-Mastenbroek, V., Gommer, E., ... Rouhl, R. (2016). Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy. In International Conference on Deep Brain Stimulation (DBS 2016) (pp. e205-e206). (Clinical Neurophysiology; Vol. 127, No. 9). Amsterdam: Elsevier. https://doi.org/10.1016/j.clinph.2016.05.256
Schaper, F. ; Zhao, Yan ; Wagner, L. ; Colon, A. ; van Kranen-Mastenbroek, V. ; Gommer, E. ; Janssen, M. ; Ackermans, L. ; van Wezel, Richard Jack Anton ; Temel, Y. ; Heida, Tjitske ; Rouhl, R. / Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy. International Conference on Deep Brain Stimulation (DBS 2016). Amsterdam : Elsevier, 2016. pp. e205-e206 (Clinical Neurophysiology; 9).
@inproceedings{eec8cb40b707455f93e8e2b1a86aa05c,
title = "Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy",
abstract = "Introduction: Patients with medically refractory epilepsy treated with deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) vary highly in their therapy response. Proper positioning of the DBS lead is crucial to maximize efficacy and minimize side effects. For a correct implantation, the ANT is anatomically located using pre-operative 3T MRI and perioperative microelectrode recordings (MER). Neurons in the ANT have highly variable, yet characteristic patterns of firing in bursts. During DBS lead implantation, we noted differences among patients’ characteristic burst patterns along the electrode trajectory. In this study, we investigate whether electrophysiological characteristics of the target region could predict therapy response to DBS and could thus be used to improve ANT targeting during DBS surgery. Objectives: To determine whether perioperative neurophysiological characteristics relate to therapy response in DBS for patients with medically refractory epilepsy. Patients and methods: We included ten consecutive epilepsy patients planned for DBS surgery at Maastricht University Medical Center. All patients were diagnosed with medically refractory epilepsy and had incapacitating seizures. Patients failed trials of at least two reasonably tolerated and adequately chosen antiepileptic drug schedules. Using pre-operative 3T MRI, we planned an extraventricular approach to target. The ANT was defined as a grey matter structure at the top of the mamillothalamic tract. Along this trajectory, we performed stereotactic single cell MERs. The anatomical location of the recordings were verified using preoperative 3T MR images. We compared characteristics of the neural signals at different depths along the trajectory between DBS responders and non-responders. Responders were defined as patients with a seizure frequency reduction of more than 50{\%} at one year follow-up. Results: Using MER data from 19 electrode trajectories of ten patients (one unilateral and nine bilateral trajectories), we found high-amplitude neuronal bursts around the target area or ANT. Responders to DBS (n = 5) had higher normalized mean firing rates and mean burst rates near the target area compared to nonresponders (n = 5), with a clearer delineation between the target region and surroundings. Electrode trajectories and lead localization did not differ between responders and non-responders. Conclusion: Single cell firing patterns in the ANT relate to therapy response in DBS for patients with medically refractory epilepsy. Analysis of single cell firing patterns using MER may guide targeting or contribute to predicting therapy response to ANT DBS. Further exploration into the use of electrophysiological recordings is warranted to improve targeting or predict outcome in DBS for epilepsy patients.",
keywords = "BSS-Electrical Neurostimulation, IR-103187, METIS-321667, EWI-27535",
author = "F. Schaper and Yan Zhao and L. Wagner and A. Colon and {van Kranen-Mastenbroek}, V. and E. Gommer and M. Janssen and L. Ackermans and {van Wezel}, {Richard Jack Anton} and Y. Temel and Tjitske Heida and R. Rouhl",
note = "10.1016/j.clinph.2016.05.256",
year = "2016",
doi = "10.1016/j.clinph.2016.05.256",
language = "Undefined",
series = "Clinical Neurophysiology",
publisher = "Elsevier",
number = "9",
pages = "e205--e206",
booktitle = "International Conference on Deep Brain Stimulation (DBS 2016)",

}

Schaper, F, Zhao, Y, Wagner, L, Colon, A, van Kranen-Mastenbroek, V, Gommer, E, Janssen, M, Ackermans, L, van Wezel, RJA, Temel, Y, Heida, T & Rouhl, R 2016, Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy. in International Conference on Deep Brain Stimulation (DBS 2016). Clinical Neurophysiology, no. 9, vol. 127, Elsevier, Amsterdam, pp. e205-e206. https://doi.org/10.1016/j.clinph.2016.05.256

Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy. / Schaper, F.; Zhao, Yan; Wagner, L.; Colon, A.; van Kranen-Mastenbroek, V.; Gommer, E.; Janssen, M.; Ackermans, L.; van Wezel, Richard Jack Anton; Temel, Y.; Heida, Tjitske; Rouhl, R.

International Conference on Deep Brain Stimulation (DBS 2016). Amsterdam : Elsevier, 2016. p. e205-e206 (Clinical Neurophysiology; Vol. 127, No. 9).

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademic

TY - GEN

T1 - Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy

AU - Schaper, F.

AU - Zhao, Yan

AU - Wagner, L.

AU - Colon, A.

AU - van Kranen-Mastenbroek, V.

AU - Gommer, E.

AU - Janssen, M.

AU - Ackermans, L.

AU - van Wezel, Richard Jack Anton

AU - Temel, Y.

AU - Heida, Tjitske

AU - Rouhl, R.

N1 - 10.1016/j.clinph.2016.05.256

PY - 2016

Y1 - 2016

N2 - Introduction: Patients with medically refractory epilepsy treated with deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) vary highly in their therapy response. Proper positioning of the DBS lead is crucial to maximize efficacy and minimize side effects. For a correct implantation, the ANT is anatomically located using pre-operative 3T MRI and perioperative microelectrode recordings (MER). Neurons in the ANT have highly variable, yet characteristic patterns of firing in bursts. During DBS lead implantation, we noted differences among patients’ characteristic burst patterns along the electrode trajectory. In this study, we investigate whether electrophysiological characteristics of the target region could predict therapy response to DBS and could thus be used to improve ANT targeting during DBS surgery. Objectives: To determine whether perioperative neurophysiological characteristics relate to therapy response in DBS for patients with medically refractory epilepsy. Patients and methods: We included ten consecutive epilepsy patients planned for DBS surgery at Maastricht University Medical Center. All patients were diagnosed with medically refractory epilepsy and had incapacitating seizures. Patients failed trials of at least two reasonably tolerated and adequately chosen antiepileptic drug schedules. Using pre-operative 3T MRI, we planned an extraventricular approach to target. The ANT was defined as a grey matter structure at the top of the mamillothalamic tract. Along this trajectory, we performed stereotactic single cell MERs. The anatomical location of the recordings were verified using preoperative 3T MR images. We compared characteristics of the neural signals at different depths along the trajectory between DBS responders and non-responders. Responders were defined as patients with a seizure frequency reduction of more than 50% at one year follow-up. Results: Using MER data from 19 electrode trajectories of ten patients (one unilateral and nine bilateral trajectories), we found high-amplitude neuronal bursts around the target area or ANT. Responders to DBS (n = 5) had higher normalized mean firing rates and mean burst rates near the target area compared to nonresponders (n = 5), with a clearer delineation between the target region and surroundings. Electrode trajectories and lead localization did not differ between responders and non-responders. Conclusion: Single cell firing patterns in the ANT relate to therapy response in DBS for patients with medically refractory epilepsy. Analysis of single cell firing patterns using MER may guide targeting or contribute to predicting therapy response to ANT DBS. Further exploration into the use of electrophysiological recordings is warranted to improve targeting or predict outcome in DBS for epilepsy patients.

AB - Introduction: Patients with medically refractory epilepsy treated with deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) vary highly in their therapy response. Proper positioning of the DBS lead is crucial to maximize efficacy and minimize side effects. For a correct implantation, the ANT is anatomically located using pre-operative 3T MRI and perioperative microelectrode recordings (MER). Neurons in the ANT have highly variable, yet characteristic patterns of firing in bursts. During DBS lead implantation, we noted differences among patients’ characteristic burst patterns along the electrode trajectory. In this study, we investigate whether electrophysiological characteristics of the target region could predict therapy response to DBS and could thus be used to improve ANT targeting during DBS surgery. Objectives: To determine whether perioperative neurophysiological characteristics relate to therapy response in DBS for patients with medically refractory epilepsy. Patients and methods: We included ten consecutive epilepsy patients planned for DBS surgery at Maastricht University Medical Center. All patients were diagnosed with medically refractory epilepsy and had incapacitating seizures. Patients failed trials of at least two reasonably tolerated and adequately chosen antiepileptic drug schedules. Using pre-operative 3T MRI, we planned an extraventricular approach to target. The ANT was defined as a grey matter structure at the top of the mamillothalamic tract. Along this trajectory, we performed stereotactic single cell MERs. The anatomical location of the recordings were verified using preoperative 3T MR images. We compared characteristics of the neural signals at different depths along the trajectory between DBS responders and non-responders. Responders were defined as patients with a seizure frequency reduction of more than 50% at one year follow-up. Results: Using MER data from 19 electrode trajectories of ten patients (one unilateral and nine bilateral trajectories), we found high-amplitude neuronal bursts around the target area or ANT. Responders to DBS (n = 5) had higher normalized mean firing rates and mean burst rates near the target area compared to nonresponders (n = 5), with a clearer delineation between the target region and surroundings. Electrode trajectories and lead localization did not differ between responders and non-responders. Conclusion: Single cell firing patterns in the ANT relate to therapy response in DBS for patients with medically refractory epilepsy. Analysis of single cell firing patterns using MER may guide targeting or contribute to predicting therapy response to ANT DBS. Further exploration into the use of electrophysiological recordings is warranted to improve targeting or predict outcome in DBS for epilepsy patients.

KW - BSS-Electrical Neurostimulation

KW - IR-103187

KW - METIS-321667

KW - EWI-27535

U2 - 10.1016/j.clinph.2016.05.256

DO - 10.1016/j.clinph.2016.05.256

M3 - Conference contribution

T3 - Clinical Neurophysiology

SP - e205-e206

BT - International Conference on Deep Brain Stimulation (DBS 2016)

PB - Elsevier

CY - Amsterdam

ER -

Schaper F, Zhao Y, Wagner L, Colon A, van Kranen-Mastenbroek V, Gommer E et al. Single cell firing patterns in the anterior nucleus of the thalamus relate to therapy response in deep brain stimulation for refractory epilepsy. In International Conference on Deep Brain Stimulation (DBS 2016). Amsterdam: Elsevier. 2016. p. e205-e206. (Clinical Neurophysiology; 9). https://doi.org/10.1016/j.clinph.2016.05.256