A novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors
Résumé
OBJECTIVE Despite the widespread use of deep brain stimulation (DBS) for movement
disorders such as Parkinson's disease (PD), the exact anatomical target responsible for the
therapeutic effect is still a subject of research. Intraoperative stimulation tests by experts consist
of performing passive movements of the patient's arm or wrist while the amplitude of the
stimulation current is increased. At each position, the amplitude that best alleviates rigidity is
identified. Intrarater and interrater variations due to the subjective and semiquantitative nature of
such evaluations have been reported. The aim of the present study was to evaluate the use of an
acceleration sensor attached to the evaluator's wrist to assess the change in rigidity, hypothesizing
that such a change will alter the speed of the passive movements. Furthermore, the combined
analysis of such quantitative results with anatomy would generate a more reproducible
description of the most effective stimulation sites.
METHODS To test the reliability of the method, it was applied during postoperative follow-up
examinations of 3 patients. To study the feasibility of intraoperative use, it was used during 9
bilateral DBS operations in patients suffering from PD. Changes in rigidity were calculated by
extracting relevant outcome measures from the accelerometer data. These values were used to
identify rigidity-suppressing stimulation current amplitudes, which were statistically compared
with the amplitudes identified by the neurologist. Positions for the chronic DBS lead implantation
that would have been chosen based on the acceleration data were compared with clinical choices.
The data were also analyzed with respect to the anatomical location of the stimulating electrode.
RESULTS Outcome measures extracted from the accelerometer data were reproducible for
the same evaluator, thus providing a reliable assessment of rigidity changes during intraoperative
stimulation tests. Of the 188 stimulation sites analyzed, the number of sites where rigiditysuppressing amplitudes were found increased from 144 to 170 when the accelerometer
evaluations were considered. In general, rigidity release could be observed at significantly lower
amplitudes with accelerometer evaluation (mean 0.9 ± 0.6 mA) than with subjective evaluation
(mean 1.4 ± 0.6 mA) (p < 0.001). Of 14 choices for the implant location of the DBS lead, only 2
were the same for acceleration-based and subjective evaluations. The comparison across
anatomical locations showed that stimulation in the fields of Forel ameliorates rigidity at similar
amplitudes as stimulation in the subthalamic nucleus, but with fewer side effects.
CONCLUSIONS This article describes and validates a new assistive method for assessing
rigidity with acceleration sensors during intraoperative stimulation tests in DBS procedures. The
initial results indicate that the proposed method may be a clinically useful aid for optimal DBS
lead placement as well as a new tool in the ongoing scientific search for the optimal DBS target
for PD.
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