Potentials and Limitations of Directional Deep Brain Stimulation: A Simulation Approach

Background: Directional leads are increasingly used in deep brain stimulation. They allow shaping the electrical field in the axial plane. These new possibilities increase the complexity of programming. Thus, optimized programming approaches are needed to assist clinical testing and to obtain full clinical benefit. Objectives: This simulation study investigates to what extent the electrical field can be shaped by directional steering to compensate for lead malposition. Method: Binary volumes of tissue activated (VTA) were simulated, by using a finite element method approach, for different amplitude distributions on the three directional electrodes. VTAs were shifted from 0 to 2 mm at different shift angles with respect to the lead orientation, to determine the best compensation of a target volume. Results: Malpositions of 1 mm can be compensated with the highest gain of overlap with directional leads. For larger shifts, an improvement of overlap of 10–30% is possible, depending on the stimulation amplitude and shift angle of the lead. Lead orientation and shift determine the amplitude distribution of the electrodes. Conclusion: To get full benefit from directional leads, both the shift angle as well as the shift to target volume are required to choose the correct amplitude distribution on the electrodes. Current directional leads have limitations when compensating malpositions >1 mm; however, they still outperform conventional leads in reducing overstimulation. Further, their main advantage probably lies in the reduction of side effects. Databases like the one from this simulation could serve for optimized lead programming algorithms in the future.

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Deep brain stimulation electrodes may rotate after implantation—an animal study

Neurosurgical Review ◽

10.1007/s10143-020-01429-6 ◽

2020 ◽

Author(s):

Alexander Rau ◽

H. Urbach ◽

V. A. Coenen ◽

K. Egger ◽

P. C. Reinacher

Keyword(s):

Deep Brain Stimulation ◽

Animal Study ◽

Brain Stimulation ◽

Electrical Field ◽

Postoperative Imaging ◽

Specific Direction ◽

Sheep Brain ◽

Burr Holes ◽

Deep Brain

Abstract Directional deep brain stimulation (dDBS) electrodes allow to steer the electrical field in a specific direction. When implanted with torque, they may rotate for a certain time after implantation. The aim of this study was to evaluate whether and to which degree leads rotate in the first 24 h after implantation using a sheep brain model. dDBS electrodes were implanted in 14 sheep heads and 3D rotational fluoroscopy (3D-RF) scans were acquired to visualize the orientation of the electrode leads. Electrode leads were clockwise rotated just above the burr holes (180° n = 6, 360° n = 6, 2 controls) and 3D-RF scans were again acquired after 3, 6, 13, 17, and 24 h, respectively. One hundred eighty degree rotated electrodes showed an initial rotation of 83.5° (range: 35.4°–128.3°) and a rotation of 114.0° (range: 57°–162°) after 24 h. With 360° torsion, mean initial rotation was 201° (range: 3.3°–321.4°) and mean rotation after 24 h 215.7° (range 31.9°–334.7°), respectively. Direct postoperative imaging may not be accurate for determining the rotation of dDBS electrodes if torque is present.

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Establishing a Standard of Care for Deep Brain Stimulation Centers in Canada

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.409 ◽

2016 ◽

Vol 44 (2) ◽

pp. 132-138 ◽

Cited By ~ 5

Author(s):

Michel Panisset ◽

Marina Picillo ◽

Nicolas Jodoin ◽

Yu-Yan Poon ◽

Alejandro Valencia-Mizrachi ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Outcome Measures ◽

Brain Stimulation ◽

Standard Of Care ◽

Thalamic Stimulation ◽

Optimal Programming ◽

Open Discussion ◽

Programming Algorithms ◽

Deep Brain

AbstractDuring the “DBS Canada Day” symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to share their knowledge regarding deep brain stimulation (DBS) management of movement disorders in three domains: (1) the programming algorithms, (2) the necessary team to run a neurosurgery program, and (3) the appropriate scales to better define in a more comprehensive fashion the effect of the brain surgery. Each presentation was followed by an open discussion, and this article reports on the conclusions of this meeting on these three questions. Concerning programming, the role of the pulse width and the switching off of the stimulation at night for thalamic stimulation for the control of tremor have been discussed. The algorithms proposed in the literature for programming in Parkinson’s disease (PD) need validation. In dystonia, the use of monopolar vs bipolar parameters, the use of low vs high frequencies and the use of smaller versus larger pulse widths all need to be examined properly. Concerning the necessary team to run a neurosurgical program, recommendations will follow the suggestions for standardized outcome measures. Regarding the outcome measures for DBS in PD, investigations need to focus on the non-motor aspects of PD. Identifying which nonmotor symptoms respond to DBS would allow a better screening before and satisfaction postoperatively. There is an important need for more data to determine the optimal programming protocol and the standard measures that should be performed routinely by all centers.

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Deep brain stimulation in movement disorders: stereotactic coregistration of two-dimensional electrical field modeling and magnetic resonance imaging

Journal of Neurosurgery ◽

10.3171/jns.2005.103.6.0949 ◽

2005 ◽

Vol 103 (6) ◽

pp. 949-955 ◽

Cited By ~ 50

Author(s):

Simone Hemm ◽

Gérard Mennessier ◽

Nathalie Vayssiere ◽

Laura Cif ◽

Hassan El Fertit ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Deep Brain Stimulation ◽

Magnetic Resonance ◽

Brain Stimulation ◽

Resonance Imaging ◽

Electrical Parameters ◽

Electrical Field ◽

Content Type ◽

Fine Print ◽

Deep Brain

Object. Adjusting electrical parameters used in deep brain stimulation (DBS) for dystonia remains time consuming and is currently based on clinical observation alone. The goal of this study was to visualize electrical parameters around the electrode, to correlate these parameters with the anatomy of the globus pallidus internus (GPI), and to study the relationship between the volume of stimulated tissue and the electrical parameter settings. Methods. The authors developed a computer-assisted methodological model for visualizing electrical parameters (the isopotential and the isoelectric field magnitude), with reference to the stereotactic target, for different stimulation settings (monopolar and bipolar) applied during DBS. Electrical field values were correlated with the anatomy of the GPI, which was determined by performing stereotactic magnetic resonance imaging in one reference patient. By using this method it is possible to compare potential and electrical field distributions for different stimulation modes. In monopolar and bipolar stimulation, the shape and distribution of the potential and electrical field are different and depend on the stimulation voltage. Distributions visualized for patient-specific parameters can be subsequently correlated with anatomical information. The application of this method to one patient demonstrated that the 0.2-V/mm isofield line fits best with the lateral GPI borders at the level of the stimulated contacts. Conclusions. The electrical field is a crucial parameter because it is assumed to be responsible for triggering action potentials. Electrical field visualization allows the calculation of the stimulated volume for a given isoline. Its application to an entire series of patients may help determine a threshold for obtaining a therapeutic effect, which is currently unknown, and consequently may aid in optimizing parameter settings in individual patients.

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Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Unipolar and Bipolar Depression

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2012.05.058 ◽

2012 ◽

Vol 2012 ◽

pp. 241-243

Author(s):

P. House

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Bipolar Depression ◽

Treatment Resistant ◽

Deep Brain

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Deep Brain Stimulation Aids Resistant Depression

Internal Medicine News ◽

10.1016/s1097-8690(08)71087-4 ◽

2008 ◽

Vol 41 (19) ◽

pp. 20

Author(s):

MICHELE G. SULLIVAN

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Resistant Depression ◽

Deep Brain

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Nicht-medikamentöse Optionen zur Behandlung pharmakoresistenter Epilepsien

Therapeutische Umschau ◽

10.1024/0040-5930/a001023 ◽

2018 ◽

Vol 75 (7) ◽

pp. 448-454

Author(s):

Thomas Grunwald ◽

Judith Kröll

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Tiefe Hirnstimulation ◽

Ketogene Diät ◽

Deep Brain

Zusammenfassung. Wenn mit den ersten beiden anfallspräventiven Medikamenten keine Anfallsfreiheit erzielt werden konnte, so ist die Wahrscheinlichkeit, dies mit anderen Medikamenten zu erreichen, nur noch ca. 10 %. Es sollte dann geprüft werden, warum eine Pharmakoresistenz besteht und ob ein epilepsiechirurgischer Eingriff zur Anfallsfreiheit führen kann. Ist eine solche Operation nicht möglich, so können palliative Verfahren wie die Vagus-Nerv-Stimulation (VNS) und die tiefe Hirnstimulation (Deep Brain Stimulation) in eine bessere Anfallskontrolle ermöglichen. Insbesondere bei schweren kindlichen Epilepsien stellt auch die ketogene Diät eine zu erwägende Option dar.

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