MaDoPO: Magnetic Detection of Positions and Orientations of Segmented Deep Brain Stimulation Electrodes: A Radiation-Free Method Based on Magnetoencephalography.

BACKGROUND: Current approaches to detect the positions and orientations of directional deep brain stimulation (DBS) electrodes rely on radiative imaging data. In this study, we aim to present an improved version of a radiation-free method for magnetic detection of the position and the orientation (MaDoPO) of directional electrodes based on a series of magnetoencephalography (MEG) measurements and a possible future solution for optimized results using emerging on-scalp MEG systems. METHODS: A directional DBS system was positioned into a realistic head-torso phantom and placed in the MEG scanner. A total of 24 measurements of 180 s each were performed with different predefined electrode configurations. Finite element modeling and model fitting were used to determine the position and orientation of the electrode in the phantom. Related measurements were fitted simultaneously, constraining solutions to the a priori known geometry of the electrode. Results were compared with the results of the high-quality CT imaging of the phantom. RESULTS: The accuracy in electrode localization and orientation detection depended on the number of combined measurements. The localization error was minimized to 2.02 mm by considering six measurements with different non-directional bipolar electrode configurations. Another six measurements with directional bipolar stimulations minimized the orientation error to 4°. These values are mainly limited due to the spatial resolution of the MEG. Moreover, accuracies were investigated as a function of measurement time, number of sensors, and measurement direction of the sensors in order to define an optimized MEG device for this application. CONCLUSION: Although MEG introduces inaccuracies in the detection of the position and orientation of the electrode, these can be accepted when evaluating the benefits of a radiation-free method. Inaccuracies can be further reduced by the use of on-scalp MEG sensor arrays, which may find their way into clinics in the foreseeable future.

CLOVER-DBS: Algorithm-Guided Deep Brain Stimulation-Programming Based on External Sensor Feedback Evaluated in a Prospective, Randomized, Crossover, Double-Blind, Two-Center Study.

BACKGROUND: Recent technological advances in deep brain stimulation (DBS) (e.g., directional leads, multiple independent current sources) lead to increasing DBS-optimization burden. Techniques to streamline and facilitate programming could leverage these innovations. OBJECTIVE: We evaluated clinical effectiveness of algorithm-guided DBS-programming based on wearable-sensor-feedback compared to standard-of-care DBS-settings in a prospective, randomized, crossover, double-blind study in two German DBS centers. METHODS: For 23 Parkinson's disease patients with clinically effective DBS, new algorithm-guided DBS-settings were determined and compared to previously established standard-of-care DBS-settings using UPDRS-III and motion-sensor-assessment. Clinical and imaging data with lead-localizations were analyzed to evaluate characteristics of algorithm-derived programming compared to standard-of-care. Six different versions of the algorithm were evaluated during the study and 10 subjects programmed with uniform algorithm-version were analyzed as a subgroup. RESULTS: Algorithm-guided and standard-of-care DBS-settings effectively reduced motor symptoms compared to off-stimulation-state. UPDRS-III scores were reduced significantly more with standard-of-care settings as compared to algorithm-guided programming with heterogenous algorithm versions in the entire cohort. A subgroup with the latest algorithm version showed no significant differences in UPDRS-III achieved by the two programming-methods. Comparing active contacts in standard-of-care and algorithm-guided DBS-settings, contacts in the latter had larger location variability and were farther away from a literature-based optimal stimulation target. CONCLUSION: Algorithm-guided programming may be a reasonable approach to replace monopolar review, enable less trained health-professionals to achieve satisfactory DBS-programming results, or potentially reduce time needed for programming. Larger studies and further improvements of algorithm-guided programming are needed to confirm these results.

Bivariate cumulative probit model for the comparison of neuronal encoding hypotheses.

Understanding the way stimulus properties are encoded in the nerve cell responses of sensory organs is one of the fundamental scientific questions in neurosciences. Different neuronal coding hypotheses can be compared by use of an inverse procedure called stimulus reconstruction. Here, based on different attributes of experimentally recorded neuronal responses, the values of certain stimulus properties are estimated by statistical classification methods. Comparison of stimulus reconstruction results then allows to draw conclusions about relative importance of covariate features. Since many stimulus properties have a natural order and can therefore be considered as ordinal, we introduce a bivariate ordinal probit model to obtain classifications for the combination of light intensity and velocity of a visual dot pattern based on different covariates extracted from recorded spike trains. For parameter estimation, we develop a Bayesian Gibbs sampler and incorporate penalized splines to model nonlinear effects. We compare the classification performance of different individual cell covariates and simple features of groups of neurons and find that the combination of at least two covariates increases the classification performance significantly. Furthermore, we obtain a non-linear effect for the first spike latency. The model is compared to a naïve Bayesian stimulus estimation method where it yields comparable misclassification rates for the given dataset. Hence, the bivariate ordinal probit model is shown to be a helpful tool for stimulus reconstruction particularly thanks to its flexibility with respect to the number of covariates as well as their scale and effect type.