Brain stimulation models, systems, devices, and methods

• US 7,346,382 B2
• Filed: 07/07/2004
• Issued: 03/18/2008
• Est. Priority Date: 07/07/2004
• Status: Active Grant

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Butson, Christopher R., McIntyre, Cameron C., Henderson, Jaimie M., Hall, John D.
• Primary Examiner(s): Casler; Brian L.
• Assistant Examiner(s): MEHTA, PARIKHA SOLANKI
• Application Number:
  US10/885,982
• Publication Number:
  US 20060017749A1
• Time in Patent Office: 1,350 Days
• Field of Search: 600/407, 600/377, 600/378, 600/408, 600/544, 607/45, 607/2, 607/116, 607/115, 607/148, 607/544, 382/131, 703/2
• US Class Current: 600/407
• CPC Class Codes: A61B 2090/364 Correlation of different images or relation of image positions in respect to the body
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61N 1/0529 Electrodes for brain stimulation
• CPC Class Codes: A61N 1/0531 Brain cortex electrodes
• CPC Class Codes: A61N 1/0534 Electrodes for deep brain stimulation
• CPC Class Codes: A61N 1/0539 Anchoring of brain electrode systems, e.g. within burr hole
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/36146 specified by the stimulation parameters
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders

Abstract

This document discusses, among other things, brain stimulation models, systems, devices, and methods, such as for deep brain stimulation (DBS) or other electrical stimulation. A model computes a volume of influence region for a simulated electrical stimulation using certain stimulation parameters, such as amplitude, pulsewidth, frequency, pulse morphology, electrode contact selection or location, return path electrode selection, pulse polarity, etc. The model uses a non-uniform tissue conductivity. This accurately represents brain tissue, which has highly directionally conductive neuron pathways yielding a non-homogeneous and anisotropic tissue medium. In one example, the non-uniform tissue conductivity is obtained from diffusion tensor imaging (DTI) data. In one example, a second difference of an electric potential distribution is used to define a volume of activation (VOA) or similar volume of influence. In another example, a neuron or axon model is used to calculate the volume of influence without computing the second difference of the electric potential distribution.

Claims

1. A computer-assisted method comprising:

a) obtaining volumetric imaging data representing an anatomic volume of a brain of a patient;

b) generating from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties;

c) using the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein calculating the volume of influence comprises at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume; and

d) selecting a recommended electrode target location in the anatomic volume using the at least one calculated volume of influence.

2. The method of claim 1, further comprising displaying, using a computerized display, the volumetric imaging data on a computer display together with at least one of:

the at least one candidate electrode target location; and

the at least one volume of influence corresponding to the displayed at least one candidate electrode target location.

3. The method of claim 2, further comprising also displaying an indication of a trajectory between an anatomic entry target location and the at least one candidate electrode target location.

4. The method of claim 1, in which the calculating the volume of influence near the candidate electrode target location in the anatomic volume includes calculating a second difference of a potential distribution to represent the volume of influence.

5. The method of claim 1, in which the calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

6. The method of claim 1, comprising calculating the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

7. A machine-accessible medium comprising instructions for:

a) obtaining volumetric imaging data representing an anatomic volume of a brain of a patient;

b) generating from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties;

c) using the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein calculating the volume of influence comprises at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

8. The machine-accessible medium of claim 7, in which the calculating the volume of influence near the at least one candidate electrode target location in the anatomic volume includes calculating at least one corresponding second difference of a potential distribution to represent the volume of influence.

9. The machine-accessible medium of claim 7, in which the calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

10. The machine-accessible medium of claim 7, comprising instructions for calculating the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

11. A computerized system comprising:

an imaging data storage circuit configured to store preoperative imaging data representing an anatomic volume of a brain of a patient;

a processor circuit, coupled to the imaging data storage circuit, the processor circuit configured to generate from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties, and wherein the processor is configured to use the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein the processor is configured to calculate the volume of influence by at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume; and

a computer display, coupled to the processor circuit, the display operable to display a recommended electrode target location in the anatomic volume using the at least one calculated volume of influence.

12. The system of claim 11, in which the processor circuit is operable to calculate the volume of influence near the at least one candidate electrode target location in the anatomic volume by calculating a second difference of a potential distribution to represent the volume of influence.

13. The system of claim 11, in which the processor circuit is operable to calculate the volume of influence using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

14. The system of claim 11, wherein the processor circuit is configured to calculate the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

15. A computer-assisted method comprising:

a) displaying volumetric imaging data representing an anatomic volume of a brain of a patient;

b) generating from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties;

c) using the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein calculating the volume of influence comprises at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume;

d) displaying the volume of influence together with the volumetric imaging data.

16. The method of claim 15, further comprising displaying, together with the displayed volume of influence and the volumetric imaging data, an indication of the first electrode target location and an indication of a trajectory between an anatomic entry target location and the first electrode target location.

17. The method of claim 15, in which the calculating the computer-modeled volume of influence near the first electrode target location in the anatomic volume includes calculating a second difference of a potential distribution to represent the volume of influence.

18. The method of claim 15, in which the calculating the computer-modeled volume of influence near the first electrode target location in the anatomic volume includes calculating the volume of influence using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

19. The method of claim 15, further including receiving user input for specifying at least one parameter of an electrical circuit for delivering the electrical stimulation, and in which the displaying the volume of influence includes displaying the volume of influence for the electrical stimulation corresponding to the specified at least one parameter.

20. The method of claim 19, in which the displaying the volume of influence includes displaying the volume of influence together with the programmed at least one parameter.

21. The method of claim 15, comprising calculating the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

22. A machine-accessible medium comprising instructions for:

a) displaying volumetric imaging data representing an anatomic volume of a brain of a patient;

b) generating from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties;

c) using the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein calculating the volume of influence comprises at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume; and

d) displaying the volume of influence together with the volumetric imaging data.

23. The machine-accessible medium of claim 22, in which the calculating the volume of influence near the first electrode target location in the anatomic volume includes calculating a second difference of a potential distribution to represent the volume of influence.

24. The machine-accessible medium of claim 22, in which the calculating the volume of influence near the first electrode target location in the anatomic volume includes calculating the volume of influence using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

25. The machine-accessible medium of claim 22, comprising instructions for calculating the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

26. A computerized system comprising:

an imaging data storage circuit configured to store volumetric imaging data representing an anatomic volume of a brain of a patient;

a processor circuit, coupled to the imaging data storage circuit, the processor circuit configured to generate from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties, and wherein the processor is configured to use the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein the processor is configured to calculate the volume of influence by at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume and

a display monitor device, coupled to the processor circuit, the display monitor device operable to display the volume of influence together with the volumetric imaging data.

27. The system of claim 26, in which the display monitor device is operable to display the volumetric imaging data along with a displayed indication of the first electrode target location, a displayed indication of an anatomic entry target location, and a displayed indication of a trajectory between the anatomic entry target location and the first electrode target location.

28. The system of claim 26, in which the processor is operable to calculate a second difference of a potential distribution to represent the volume of influence.

29. The system of claim 26, in which the processor is operable to calculate the volume of influence near the first electrode target location in the anatomic volume using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

30. The system of claim 26, further including means for specifying at least one parameter of an electrical circuit for delivering the electrical stimulation, and in which the display monitor is operable to display the volume of influence for the electrical stimulation corresponding to the specified at least one parameter.

31. The system of claim 26, wherein the processor circuit is configured to calculate the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

32. A computer-assisted method comprising:

obtaining imaging data of an anatomic volume of a brain of a patient;

displaying volumetric imaging data representing the anatomic volume;

displaying a user-selectable first electrode location in the volumetric imaging data;

generating from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties;

using the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein calculating the volume of influence comprises at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume;

determining a correlation between the calculated volume of influence and a target volume of influence; and

adjusting at least one of the first electrode location and at least one stimulation parameter using information associated with the correlation between the calculated volume of influence and a target volume of influence.

33. The method of claim 32, further comprising displaying a trajectory between an anatomical entry point and the first electrode location.

34. The method of claim 32, in which the first electrode location is a target location for placing an electrode.

35. The method of claim 32, in which the first electrode location is an actual location at which an electrode is located.

36. The method of claim 32, in which the electrode includes multiple electrode contacts, and at least one of the electrode contacts is located at the first electrode location.

37. The method of claim 32, in which the adjusting includes selecting at least one particular electrode contact from a plurality of electrode contacts associated with the electrode.

38. The method of claim 37, in which the adjusting includes adjusting a stimulation amplitude.

39. The method of claim 37, in which the adjusting includes adjusting a stimulation pulsewidth.

40. The method of claim 37, in which the adjusting includes adjusting a stimulation frequency.

41. The method of claim 37, in which the adjusting includes adjusting a selection of return path electrode.

42. The method of claim 32, comprising calculating the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

43. A machine-accessible medium comprising instructions for:

obtaining imaging data of an anatomic volume of a brain of a patient;

displaying volumetric imaging data representing the anatomic volume;

displaying a user-selectable first electrode location in the volumetric imaging data;

generating from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties;

using the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein calculating the volume of influence comprises at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume;

determining a correlation between the calculated volume of influence and a target volume of influence; and

adjusting at least one of the first electrode location and at least one stimulation parameter using information associated with the correlation between the calculated volume of influence and a target volume of influence.

44. The machine-accessible medium of claim 43, further comprising instructions for displaying a trajectory between a user-selectable anatomic entry point and the first electrode location.

45. The machine-accessible medium of claim 43, in which the calculating the volume of influence near the first electrode location in the anatomic volume includes calculating a second difference of a potential distribution to represent the volume of influence.

46. The machine-accessible medium of claim 43, in which the calculating the volume of influence near the first electrode location in the anatomic volume includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

47. The machine-accessible medium of claim 43, comprising instructions for calculating the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

48. A system comprising:

an imaging data storage device to store imaging data representing an anatomic volume of a brain of a patient;

a processor circuit, coupled to the imaging data storage device, the processor circuit configured to generate from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties, and wherein the processor is configured to use the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein the processor is configured to calculate the volume of influence by at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume, the processor also operable to determine a correlation between the calculated volume of influence and a target volume of influence, and in which the processor is also operable to adjustably output at least one of a desirable first electrode location and a desirable at least one stimulation parameter setting using the correlation; and

a display, operable to display an indication of at least one of the desirable first electrode location and the desirable at least one stimulation parameter setting.

49. The system of claim 48, in which the processor is operable to calculate the volume of influence near the first electrode location in the anatomic volume includes calculating a second difference of a potential distribution to represent the volume of influence.

50. The system of claim 48, in which the processor is operable to calculate the volume of influence near the first electrode location in the anatomic volume includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume.

51. The system of claim 48, wherein the processor circuit is configured to calculate the at least one volume of influence without requiring measuring an electrophysiological response from the patient.

52. A computer-implemented system including:

an imaging data storage circuit configured to store preoperative imaging data representing an anatomic volume of a brain of a patient;

a processor circuit, coupled to the imaging data storage circuit, the processor circuit configured to generate from the volumetric imaging data a computer model that allows a non-uniform conductivity to represent inhomogeneous and anisotropic tissue properties, and wherein the processor is configured to use the computer model to calculate at least one volume of influence, wherein the volume of influence comprises a predicted volume of tissue affected by an electrical stimulation delivered by an electrode at a corresponding at least one candidate electrode target location, and wherein the processor is configured to calculate the volume of influence by at least one of;

i) calculating a second difference of a potential distribution to represent the volume of influence;

or

ii) calculating the volume of influence includes using an electric field model together with a multi-compartment neuron model oriented and positioned to represent at least one actual nerve pathway in the anatomic volume; and

a graphical user interface, the user interface including a display configured to represent the volume of influence of a specific patient using a patient-specific model that incorporates an indication of tissue conductivity data from imaging data from the specific patient, and using a specific electrode location and specific setting of stimulation parameters, the display also including a patient-specific volumetric representation of a segmented target region of brain tissue.

53. The system of claim 52, further including a processor circuit configured to calculate the volume of influence using a finite element model of electric field that incorporates non-uniform conductivity data to represent inhomogeneous and anisotropic tissue properties, and using a neuron model positioned along at least one nerve pathway represented by the finite element model.

54. The system of claim 53, in which the processor circuit is configured to calculate a second difference of an electric potential distribution to obtain the volume of influence.

55. The system of claim 53, wherein the processor circuit is configured to calculate the at least one volume of influence without requiring measuring an electrophysiological response from the patient.