Deep brain stimulation (DBS) was initially employed to cure intractable tremor in the early 1990s¹ by A. Benabid, a French mathematician and stereotactic neurosurgeon who, at that time, described  bilateral subthalamic nucleus DBS for advanced Parkinson disease (PD).² Coubes in Montpellier³ utilized chronic bilateral stimulation of the internal globus pallidus to cure generalized dystonia. In the United States, the Food and Drug Administration  approved DBS for essential tremor in 1997, for PD in 2002, and for dystonia in 2003. In 2013, more than 100,000 patients worldwide have been treated with DBS.

At the Pitié-Salpêtrière Hospital in Paris we have worked on brain imaging for DBS since the early 1990s. Early investigators used  primitive ventriculography to identify targeted nuclei indirectly. We developed modern MRI-based techniques and have improved the accuracy of stereotactic MRI through direct visualization of the targeted structures, achieving accuracy to the level of one pixel.⁴ We used MR to implant DBS electrodes to treat patients with essential tremor.⁵

All DBS procedures in our center are performed using MR guidance. We have also worked on the identification of the subthalamic nucleus in MRI⁶ and since the beginning of 2000s, we have developed a new 3D atlas of the basal ganglia with J. Yelnik and E. Bardinet.⁷ Our work in neuroradiology has led to the publication of numerous articles, in collaboration with teams from neuroscience and neurosurgery, on the results of DBS in PD and also in obsessive-compulsive disorders, dystonia, and Tourette disease. The combination of MRI identification of nuclei with the 3D atlas of the basal ganglia developed facilitated fundamental discoveries on the role of the basal ganglia in patients treated with DBS.

The review article published by AJNR in 2010 on neuroimaging and DBS⁸ summarized worldwide progress since the first description of DBS. We reviewed the use of brain imaging for patient selection, target nucleus localization, postoperative complications detection, and final electrode contact selection. Our experience and reports in the literature demonstrate that that active neuroradiologist  involvement in these procedures is critical to their success. A multidisciplinary approach is

essential to obtain high-quality results for patients. It is also necessary for progress in research on the application of DBS to other neurodegenerative diseases and even some psychiatric illnesses. Our future research will be centered mainly on the use of new MRI sequences to delineate the targeted nuclei, and on the use of 3T MRI in stereotactic conditions.

As I mentioned above, work on DBS must be a multidisciplinary team effort. I want to thank here the  neurosurgical group: Prof. Ph. Cornu, Dr. S. Navarro, and Dr. C. Karachi; the neurophysiological group: Dr. B. Pidoux and Dr. ML Welter; the neurological and psychiatric group: Prof. Y. Agid, Pr. M. Vidailhet, Dr. L. Mallet, Dr. D. Grabli, and Dr. A.M. Bonnet; in our neuroradiology department, Dr. D. Galanaud; and many others who have worked on this subject in our center.

References

1. Benabid AL, Pollak P, Gervason C, et al. Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 1991;337:403–06
2. Limousin P, Pollak P, Benazzouz A, et al. Effect on Parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 1995;345:91–95
3. Coubes P, Echenne B, Roubertie B, et al. [Treatment of early-onset generalized dystonia by chronic bilateral stimulation of the internal globus pallidus. Apropos of a case]. Neurochirurgie 1999;45:139–44 [in French]
4. Dormont D, Zerah M, Cornu P, et al. A technique of measuring the precision of an MR-guided stereotaxic installation using anatomic specimens. AJNR Am J Neuroradiol 1994;15:365–71
5. Dormont D, Cornu P, Pidoux B, et al. Chronic thalamic stimulation with 3D MR stereotactic guidance. AJNR Am J Neuroradiol 1997;18:1093–107
6. Dormont D, Ricciardi KG, Tandé D, et al. Is the subthalamic nucleus hypointense on T2-weighted images? A correlation study using MR imaging and stereotactic atlas data. AJNR Am J Neuroradiol 2004;25:1516–23
7. Yelnik J, Bardinet E, Dormont D, et al. A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data. Neuroimage 2007;34:618–38
8. Dormont D, Seidenwurm D, Galanaud D, et al. Neuroimaging and deep brain stimulation. AJNR Am J Neuroradiol 2010;31:15–23  

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