Method and system for combining anatomical connectivity patterns and navigated brain stimulation
When operating a brain stimulation device, it is critical to understand and control the network effects associated with the area being targeted for stimulation. The combined system and methods provided herein provides the operator with a real-time view of the brain network potentially affected by the stimulation. The system and method are capable of increasing the accuracy of diagnostic information. Additionally, disclosed herein are a system and method for combining navigated brain stimulation data and anatomical data with brain connectivity data for an individual.
1 . A method for combining non-invasive transcranial stimulation navigation with functional data, said method comprising the steps of;
acquiring an anatomical image of a brain,
acquiring functional data of the brain,
coregistering at least a portion of the functional data, said portion being associated with a portion of interest of the brain, with a corresponding location from the anatomical image in order to form a combined view of the brain,
stereotactically aligning the combined view of the brain and a transcranial magnetic stimulation (TMS) stimulation device in real-time,
providing a view of the combined view of the brain containing a real-time indication on a brain network potentially affected by stimulation based on the stereotactically aligned combined view of the brain and the TMS stimulation device,
identifying a first region of interest of the brain associated with a particular function,
identifying a second region of interest of the brain intracranially connected to said first region based at least on the combined view and navigated TMS mapping data, and
indirectly stimulating the first region of interest of the brain by applying stimulation to the second region of interest of the brain.
2 . A method according to claim 1 , further comprising the step of displaying the combined view of the brain having functional data for at least a portion of interest of the brain associated with the corresponding location on the anatomical image.
3 . A method according to claim 1 , wherein the anatomical image of the brain is stereotactically aligned with a subject's head with TMS navigation software.
4 . A method according to claim 1 , further comprising the step of tagging a three-dimensional volume on or within the combined view with a brain function determined by completing a navigated TMS process.
5 . A method according to claim 1 , further comprising the steps of further combining navigated TMS mapping data with the combined view of the brain and selecting a seed region, within a navigated TMS mapped region, for applying a tractography algorithm.
6 . A method according to claim 5 , further comprising the step of using said seed region in the tractography algorithm to determine white matter tracts.
7 . A method according to claim 6 , further comprising the step of combining the white matter tracts with the combined view and displaying the white matter tracts on or within the combined view.
8 . A method according to claim 5 , wherein the tractography algorithm is applied in real-time and results of the algorithm are displayed to a navigated TMS operator during stimulation or off-line wherein the results are used for surgical or treatment planning.
9 . A method according to claim 5 , further comprising stimulating an area of the brain corresponding to a terminal end region of white matter tracts determined by the tractography algorithm.
10 . A method according to claim 9 , further comprising verifying an intracranial connection between the seed region and the terminal end region by navigated TMS mapping of the terminal end region.
11 . A method according to claim 9 , further comprising determining a new seed region and repeating at least a portion of the method steps thereafter if the terminal end region does not correspond to the new seed region.
12 . A method according to claim 1 , wherein the applied stimulation is at least one TMS pulse, a direct stimulation or a deep brain stimulation.
13 . A method according to claim 1 , further comprising the steps of:
tracking a navigated TMS coil in relation to a subject's head, wherein a location and orientation of the subject's head is co-registered with at least a portion of the combined view,
determining a predicted stimulation which would be applied to the subject by the coil at a particular location,
assigning a location of said predicted stimulation as a seed for a tractography algorithm,
determining white matter tracts from the tractography algorithm utilizing the seed, and
displaying the determined white matter tracts on and/or within the combined view.
14 . A method according to claim 13 , wherein the predicted white matter tracts are calculated in real time and displayed prior to stimulation of the location.
15 . A method according to claim 13 , further comprising the step of tagging the location of said predicted stimulation.
16 . A method according to claim 13 , further comprising the step of cross-validating functional data and navigated brain stimulation data via Boolean operations between the determined white matter tracts and navigated brain stimulation responses.
17 . A method according to claim 1 , wherein the functional data is positron emission tomography (PET) data, functional magnetic resonance imaging (fMRI) data, resting state-fMRI, or diffusion tensor imaging (DTI) data.
18 . The method according to claim 1 , further comprising the step of mapping a portion of the brain using navigated TMS based on the combined view.
19 . The method according to claim 1 , further comprising the step of selecting a location of the brain to target with a TMS pulse based on the combined view.
20 . The method according to claim 19 , wherein the functional data is positron emission tomography (PET) data, functional magnetic resonance imaging (fMRI) data, resting state-fMRI, or diffusion tensor imaging (DTI) data.
21 . The method according to claim 1 , further comprising the step of modeling, in real time, via a physics modeling system, E-fields generated, or to be generated, by the TMS stimulation device.
22 . The method according to claim 21 , wherein the second region of interest is identified based further on at least the E-fields generated, or to be generated, by the TMS stimulation device.
23 . A non-transitory computer readable medium having stored there on a set of computer readable instructions for causing one or more processors to carry out the steps of:
acquiring an anatomical image of a brain,
acquiring functional data of the brain,
coregistering at least a portion of the functional data, said portion being associated with a portion of interest of the brain, with a corresponding location from the anatomical image in order to form a combined view of the brain,
stereotactically aligning the combined view of the brain and a transcranial magnetic stimulation (TMS) stimulation device in real-time,
providing a view of the combined view of the brain containing a real-time indication on a brain network potentially affected by stimulation based on the stereotactically aligned combined view of the brain and the TMS stimulation device,
identifying a first region of interest of the brain associated with a particular function,
identifying a second region of interest of the brain intracranially connected to said first region based at least on the combined view and navigated TMS mapping data, and
indirectly stimulating the first region of interest of the brain by applying stimulation to the second region of interest of the brain.
24 . A computer assisted stereotactic positioning system and transcranial magnetic stimulation (TMS) system comprising:
a TMS stimulation device,
a stereotactic arrangement connected to the TMS stimulation device in order to guide the TMS stimulation device,
non-transitory computer readable medium having stored there on a set of computer readable instructions for causing one or more processors to carry out the steps of:
acquiring an anatomical image of a brain,
acquiring functional data of the brain,
coregistering at least a portion of the functional data, said portion being associated with a portion of interest of the brain, with a corresponding location from the anatomical image in order to form a combined view of the brain,
stereotactically aligning the combined view of the brain and the TMS stimulation device in real-time in order to create a stereotactic frame for use in guiding the TMS stimulation device via the stereotactic arrangement,
providing a view of the combined view of the brain containing a real-time indication on a brain network potentially affected by stimulation based on the stereotactically aligned combined view of the brain and the TMS stimulation device,
identifying a first region of interest of the brain associated with a particular function,
identifying a second region of interest of the brain intracranially connected to said first region based at least on the combined view and navigated TMS mapping data, and
indirectly stimulating the first region of interest of the brain by applying stimulation to the second region of interest of the brain,
wherein the system is configured to provide said indication on the brain network potentially affected by stimulation in real-time during stimulation.