title: The optimal pallidal target in deep brain stimulation for dystonia: a study using a functional atlas based on nonlinear image registration.
abstract: BACKGROUND
  Deep brain stimulation (DBS) of the globus pallidus internus is established as efficacious for dystonia, yet the optimal target within this structure is not well defined. Published evidence suggests that spatial normalization provides a better estimate of DBS lead location than traditional methods based on standard stereotactic coordinates.
  
  
  METHODS
  We retrospectively reviewed our pallidal implanted dystonia population. Patient imaging scans were morphed into an MRI atlas using a nonlinear image registration algorithm. Active contact locations were projected onto the atlas and clusters analyzed for the degree of variance in two groups: (1) good and poor responders and (2) cervical (CD) and generalized dystonia (GD).
  
  
  RESULTS
  The average active contact location between CD and GD good responders was distinct but not significantly different. The mean active contact for CD poor responders was significantly different from CD responders and GD poor responders in the dorsoventral direction.
  
  
  CONCLUSIONS
  A normalized imaging space is arguably more accurate in visualizing postoperative leads. Despite some separation between groups, this data suggests there was not an optimal pallidal target for common dystonia patients. Degrees of variance overlapped due to a large degree of individual target variation. Patient selection may ultimately be the key to maximizing patient outcomes.
authors.affiliation: A-0118 Medical Center North, Vanderbilt University, Nashville, Tenn., USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tolleson
authors.forename: Srivatsan
authors.initials: S
authors.lastname: Pallavaram
authors.forename: Chen
authors.initials: C
authors.lastname: Li
authors.forename: John
authors.initials: J
authors.lastname: Fang
authors.forename: Fenna
authors.initials: F
authors.lastname: Phibbs
authors.forename: Peter
authors.initials: P
authors.lastname: Konrad
authors.forename: Peter
authors.initials: P
authors.lastname: Hedera
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: D'Haese
authors.forename: Benoit M
authors.initials: BM
authors.lastname: Dawant
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001271:Atlases as Topic; D001931:Brain Mapping / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005917:Globus Pallidus / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult