Method and system for combining anatomical connectivity patterns and navigated brain stimulation

Abstract

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 the corresponding location from the anatomical image, and   stereotactically aligning the combined view of the brain with transcranial magnetic stimulation (TMS) navigation software.   
     
     
         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 . (canceled) 
     
     
         5 . 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 from navigated TMS. 
     
     
         6 . (canceled) 
     
     
         7 . (canceled) 
     
     
         8 . (canceled) 
     
     
         9 . (canceled) 
     
     
         10 . A method according to  claim 1 , further comprising the steps of further combining navigated TMS mapping data with the combined view and selecting a seed region, within a navigated TMS mapped region, for applying a tractography algorithm. 
     
     
         11 . A method according to  claim 10 , further comprising the step of using said seed region in the tractography algorithm to determine white matter tracts. 
     
     
         12 . A method according to  claim 11 , 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. 
     
     
         13 . (canceled) 
     
     
         14 . A method according to  claim 10 , wherein a tractography algorithm is applied in real-time and the results are displayed to a navigated TMS operator during stimulation or off-line wherein the results are used for surgical or treatment planning. 
     
     
         15 . (canceled) 
     
     
         16 . A method according to  claim 10 , further comprising stimulating an area of the brain corresponding to a terminal end of white matter tracts determined by the tractography algorithm. 
     
     
         17 . A method according to  claim 16 , further comprising verifying an intracranial connection between the seed region and the terminal end region by navigated TMS mapping of the terminal end region. 
     
     
         18 . A method according to  claim 16 , 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 function of the seed region. 
     
     
         19 . A method according to  claim 1 , further comprising the steps of;
 identifying a first region of interest of the brain associated with a particular function,   identifying a second region of interest of the brain intracranial connected to said first region based at least on the combined view and/or 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.   
     
     
         20 . (canceled) 
     
     
         21 . A method according to  claim 19 , wherein the applied stimulation is at least one TMS pulse, a direct stimulation or a deep brain stimulation. 
     
     
         22 . (canceled) 
     
     
         23 . (canceled) 
     
     
         24 . A method according to  claim 19 , further comprising the step of determining an activating function which approximates the volume of activation around a terminal end of one or more white matter tracts. 
     
     
         25 . (canceled) 
     
     
         26 . (canceled) 
     
     
         27 . A method according to  claim 10 , wherein the seed selection is based on an area which when stimulated produces a normalized EMG or EEG response exceeding a predefined value or on an area where white matter signal intensity and an E-field threshold value overlap. 
     
     
         28 . (canceled) 
     
     
         29 . (canceled) 
     
     
         30 . A method according to  claim 1 , further comprising the steps of;
 tracking a navigated TMS coil in relation to a subject's head, wherein the 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 the location of said predicted stimulation as a seed for a tractography algorithm,   determining white matter tracts from the tractography algorithm utilizing the predicted seed, and   displaying the predicted white matter tracts on and/or within the combined view.   
     
     
         31 . A method according to  claim 30 , wherein the predicted white matter tracts are calculated in real time and displayed prior to stimulation of the location. 
     
     
         32 . A method according to  claim 30 , further comprising the step of tagging the predicted stimulation location. 
     
     
         33 . (canceled) 
     
     
         34 . (canceled) 
     
     
         35 . A method according to  claim 1 , further comprising the step of cross-validating functional data and navigated brain stimulation data via Boolean operations between determined white matter tracts and navigated brain stimulation responses. 
     
     
         36 . (canceled) 
     
     
         37 . (canceled) 
     
     
         38 . A method according to  claim 1 , wherein the functional data is positron emission tomography (PET) data, functional magnetic resonance imaging (fMRI) data, or diffusion tensor imaging (DTI) data. 
     
     
         39 . (canceled) 
     
     
         40 . (canceled) 
     
     
         41 . (canceled) 
     
     
         42 . A system for combining Navigated Brain Stimulation (NBS) and anatomical connectivity patterns, said system comprising;
 an NBS module, and   a Diffuser Tensor Imaging (DTI) module in communication with the NBS module,   wherein the NBS module is configured to provide seed's to the DTI module, and   wherein the DTI module is configured to provide white matter tracts to the NBS module for validation.   
     
     
         43 . A system according to  claim 42 , wherein the NBS module comprises a real time physics modeling system, a stimulating device and a stereotactic navigation device. 
     
     
         44 . A system according to  claim 42 , wherein the system further comprises an image processing system configured to coregister anatomical data to DTI data. 
     
     
         45 . A system according to  claim 43 , wherein the physics modeling system is configured to provide real time physics modeling of E-fields generated, or to be generated, by the stimulating device. 
     
     
         46 . A system according to  claim 42 , further comprising a display module configured to simultaneously display real time E-fields generated, or to be generated, by a portion of the NBS module and at least one calculated white matter tract calculated by the DTI module.