Investigator:
Enrico Opri, PhD
Name of Institution:
The Regents of the University of Michigan, Ann Arbor, MI
Project Title:
Stimulation induced evoked potentials for guided intra and post-operative functional mapping
Investigator Bio:
Dr. Enrico Opri is an Assistant Professor at University of Michigan within the Department of Biomedical Engineering. He is a core faculty within the Biointerfaces Institute, and he is affiliated with the Michigan Neuroscience Institute (MNI). He received his PhD in Biomedical Engineering at the University of Florida, where he focused on closed-loop deep brain stimulation (DBS) for the improved treatment of patients affected by essential tremor and the mechanism of thalamocortical communication in motor behavior in humans. As a postdoctoral fellow, his research interest focused on engineering-guided and objective electrophysiology-based methodologies for the improvement and enhancement of DBS programming and surgical implantation in Parkinson’s disease (PD).
His research interests are in exploring the electrophysiological markers within the basal ganglia, thalamic, and cortical circuits affected by neurological disorders (such as Parkinson’s, Tourette, Essential Tremor, epilepsy). He interested in identifying how stimulation (deep brain stimulation) alters this network to bring a therapeutic benefit, with the overall goal to identify neurological markers that can be leveraged to improve and enhance current state of the art therapies within movement disorders such as PD.
Objective:
To investigate the use of deep brain stimulation (DBS) local evoked potentials for directional-based anatomic targeting during asleep DBS surgery to provide enhanced mapping information for DBS clinical targeting.
Background:
DBS has become a routine therapy for patients affected by PD, which requires the implantation of DBS leads within specific brain regions, to deliver brief electrical pulses to control the motor symptoms of PD. One of the most important factors to ensure the best therapeutic effect and minimize side effects of the stimulation, is the correct placement of the leads within the brain target region, which typically is performed with awake functional mapping. We propose to use instead DBS local evoked potentials (DLEP) as alternative mapping methodology, as it is detectable under general anesthesia, and is suggested to be maximal within the DBS clinical target.
Methods/Design:
We will evaluate DLEPs during standard DBS surgeries – both in the awake phase and the asleep phase (using propofol as the anesthetic agent), using directional leads. These evaluations will seek to assess the feasibility and accuracy of the DLEP-based localization in estimating and validating the optimal DBS target location, comparing it the microelectrode recording approach. Furthermore, we will test the predictive power of the intraoperative DLEP-based localization in informing which DBS contacts provide the patient with the best motor therapeutic benefit post-operatively. The proposed methodology would allow obtaining direct information for adjusting the DBS surgical trajectories using directional electrodes, thus decreasing further any risk during surgery.
Relevance to Diagnosis/Treatment of Parkinson’s Disease:
This success of this study will enable the integration of the benefit of brain mapping (based on DLEP), with the benefits of asleep surgery leading to better DBS surgical targeting and implantation, increasing the accessibility of DBS implantation surgery and postoperative care for patients affected by PD.