Functional Magnetic Resonance Imaging (fMRI) During Deep Brain Stimulation (DBS) to Treat Parkinson's Disease
Condition: Parkinson Disease; Essential Tremor; Dystonia; Obsessive Compulsive Disorder
MeSH terms: Parkinson Disease; Dystonia; Essential Tremor; Obsessive-Compulsive Disorder
Study type: Observational

Summary: 
      This study is investigating the usefulness of using functional magnetic resonance imaging
      (fMRI) to monitor brain activation during deep brain stimulation for Parkinson's Disease,
      Essential tremor, dystonia, OCD, depression, pain, Tourette's syndrome, and epilepsy. The
      study may determine the relationship between patterns of brain activation and therapeutic
      outcome and/or side effects.
    

Detailed description: 
      Deep brain stimulation (DBS) is an effective neurosurgical approach for treating motor
      disorders including Parkinson's disease (PD), Essential Tremor (ET), and dystonia. Its
      therapeutic benefit has led to the application of DBS to a wide spectrum of disorders
      including psychiatric conditions, epilepsy, Alzeimer's disease, headache,
      obsessive-compulsive disorder (OCD), Tourette syndrome, depression and intractable pain.
      However, because the nature of its underlying mechanisms and clinical effects are not fully
      understood, precision targeting, decreasing adverse effects, and improving clinical outcomes
      represent major clinical and scientific challenges in PD and other disorders treated by DBS.
      Our goal is to investigate the inter-relationships between site-specific neural activation
      and clinical outcomes during DBS. To do so, we will perform non-invasive functional Magnetic
      Resonance Imaging (fMRI) to investigate DBS-mediated activation of neural network circuitry.
      Our proposed protocol involves the addition of intraoperative fMRI to the standard DBS or
      battery change protocol in order to determine the major sites of activation during
      application of clinically effective DBS to the subthalamic nucleus (STN), ventral
      intermediate thalamus (VIM), globus pallidus interna (GPi), fornix, nucleus accumbens (NAc),
      anterior thalamus and periaqueductal gray matter. Patients will undergo clinical assessment
      to determine the relative efficacy of DBS stimulation parameters, applied during the fMRI and
      at regularly scheduled post-operative programming visits up to 6 months of follow-up. Our
      Specific Aims are to: (1) Identify fMRI-activated brain regions by DBS in patients who
      undergo DBS surgery (Patients diagnosed with PD, ET, dystonia, OCD, depression, pain,
      Tourette's syndrome, and epilepsy. (2) Correlate fMRI activation with clinical outcomes and
      side effects. With the goal of improving DBS electrode targeting for optimal and reproducible
      clinical outcomes, these experiments will be the first attempt to relate site-specific DBS
      with functional in vivo imaging data and quantitative longitudinal clinical outcome measures
      in DBS patients.
    

Intervention name(s): Functional Magnetic Resonance Imaging (fMRI)
Intervention type(s): Procedure
Intervention description(s): During the deep brain stimulation (DBS) surgery of the subthalamic nucleus within the thalamocortical basal ganglion, an additional lead extendor will be connected to the DBS electrode to allow externalization of the lead. Following confirmation of electrode location with MRI, a series of fMRI scans will be run. Total scanning time will be limited to 35 minutes.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients approved and scheduled to undergo the clinical procedure of Deep Brain
        stimulation.
      
Keywords: Parkinson disease; Deep Brain Stimulation; Functional Magnetic Resonance Imaging