Multiple Objective Particle Swarm Optimization Postural Instability Gait Disorder
University of Minnesota
Summary
Sixty patients will be enrolled in this study who are treated for Parkinson's disease (PD) with bilateral deep brain stimulation of subthalamic nucleus (STN) or globus pallidus (GP), who have a pre- operative 7 Tesla MRI including diffusion tensor imaging for tractography and a postoperative head CT for electrode localization, and in whom at least 3 months have passed since activation of their neurostimulators, for stabilization of clinical stimulator settings. Using their MRI and CT, the investigators will construct patient-specific models of electrical current spread to neuroanatomical tar- gets surrounding the electrode. Then applying nonlinear (particle swarm) optimization, patient- specific stimulator settings will be designed to maximally or minimally activate specific path- ways. In STN DBS: pedunculopallidal vs. pallidopeduncular pathways. In GP DBS: pallidopeduncular pathways at its origin in GP pars interna (GPi) vs. inhibitory afferents to GPi (from GP pars externa GPe). All stimulation falls within the the FDA-approved range for DBS for PD.
Description
Patients will undergo on-label DBS for the treatment of Parkinson's disease, at stimulator settings different from their usual settings, but within the FDA-approved range for this indication, based on patient specific models that identify stimulation settings that most selectively target one pathway over other adjacent pathways. In Aim 1 (STN DBS), the comparison will be amongst settings that selectively target pedunculopallidal, pallidopeduncular and subthalamopallidal pathways. In Aim 2 (GP DBS), the comparison will be amongst settings which selectively target the pallidopeduncular pathways…
Eligibility
- Age range
- 18–89 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Diagnosis of PD * Bilateral DBS * Directional DBS electrode system * MRI, at least 7 Tesla, with diffusion tensor imaging, prior to DBS surgery * Head CT, at least 1mm cuts, following DBS surgery * At least 3 months since initial activation of the neurostimulator Exclusion Criteria: * Neurological or musculoskeletal disorder that significantly affects gait, balance, or limb movements * Dementia * Prior stereotactic neurosurgery other than DBS for movement disorder * Pregnancy
Interventions
- OtherDeep Brain Stimulation, STN
DBS of the STN, within FDA-approved limits and labeling, for symptoms of PD
- OtherGP Deep Brain Stimulation
PD with GP DBS, within FDA-approved limits and labeling, for symptoms of PD.
Location
- University of MinnesotaMinneapolis, Minnesota