374 Modeling the Effects of Current Steering With Directional Leads

Krishnan, Tushar; Mustakos, Richard; Steinke, G. Karl

doi:10.1227/01.neu.0000489862.00935.a3

Cited by 3 publications

(3 citation statements)

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“…Reduction of TT can be explained by the difference of VNA evoked by dDBS compared to oDBS. An increment of stimulation intensity by the same amount of current leads to a greater increase of VNA when stimulating directionally compared to oDBS (25,26). In this relation, a greater increase of VNA, when stimulating directionally, might lead to loss of directionality, which may explain why the current strength at SET did not differ among the four conditions.…”

Section: Discussionmentioning

confidence: 99%

Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor Increases Therapeutic Window

Bruno

Nikolov

Hartmann

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Objectives Deep brain stimulation (DBS) of the posterior subthalamic area (PSA) and the ventral intermediate thalamic nucleus (VIM) is a well‐established therapy for essential tremor (ET), but it is frequently associated with side effects like dysarthria or gait ataxia. Directional DBS (dDBS) may be a way to activate fiber tracts more selectively. Is dDBS for ET superior to omnidirectional DBS (oDBS) regarding therapeutic window and clinically as effective as oDBS? Materials and Methods Ten patients with ET treated with PSA/VIM‐DBS were recruited. Therapeutic window served as primary outcome parameter; clinical efficacy, volume of neuronal activation, and total electrical energy delivered (TEED) served as secondary outcome parameters. Therapeutic window was calculated for all three dDBS directions and for oDBS by determining therapeutic thresholds and side effect thresholds. Clinical efficacy was assessed by comparing the effect of best dDBS and oDBS on tremor and ataxia rating scales, and accelerometry. Volume of neural activation and TEED were also calculated for both paradigms. Results For best dDBS, therapeutic window was wider and therapeutic threshold was lower compared to oDBS. While side effect threshold did not differ, volume of neural activation was larger for dDBS. In terms of clinical efficacy, dDBS was as effective as oDBS. Conclusions dDBS for ET widens therapeutic window due to reduction of therapeutic threshold. Larger volume of neural activation for dDBS at side effect threshold supports the notion of persistent directionality even at higher intensities. dDBS may compensate for slightly misplaced leads and should be considered first line for PSA/VIM‐DBS.

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Section: Discussionmentioning

confidence: 99%

Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor Increases Therapeutic Window

Bruno

Nikolov

Hartmann

et al. 2021

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

show abstract

“…If side effects are caused by stimulation of non-target tissue, they may be reduced by adapting the spatial extent of the current spread to the target’s anatomical borders by appropriate electrode designs as introduced, e.g. by [ 89 – 91 ], in particular, to spatially tailor stimuli by means of directional DBS [ 92 – 97 ]. However, some side effects may at least partly be caused by stimulating the target region itself [ 98 , 99 ].…”

Section: Introductionmentioning

confidence: 99%

How stimulation frequency and intensity impact on the long-lasting effects of coordinated reset stimulation

Manos

Zeitler²,

Tass

2018

PLoS Comput Biol

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Several brain diseases are characterized by abnormally strong neuronal synchrony. Coordinated Reset (CR) stimulation was computationally designed to specifically counteract abnormal neuronal synchronization processes by desynchronization. In the presence of spike-timing-dependent plasticity (STDP) this may lead to a decrease of synaptic excitatory weights and ultimately to an anti-kindling, i.e. unlearning of abnormal synaptic connectivity and abnormal neuronal synchrony. The long-lasting desynchronizing impact of CR stimulation has been verified in pre-clinical and clinical proof of concept studies. However, as yet it is unclear how to optimally choose the CR stimulation frequency, i.e. the repetition rate at which the CR stimuli are delivered. This work presents the first computational study on the dependence of the acute and long-term outcome on the CR stimulation frequency in neuronal networks with STDP. For this purpose, CR stimulation was applied with Rapidly Varying Sequences (RVS) as well as with Slowly Varying Sequences (SVS) in a wide range of stimulation frequencies and intensities. Our findings demonstrate that acute desynchronization, achieved during stimulation, does not necessarily lead to long-term desynchronization after cessation of stimulation. By comparing the long-term effects of the two different CR protocols, the RVS CR stimulation turned out to be more robust against variations of the stimulation frequency. However, SVS CR stimulation can obtain stronger anti-kindling effects. We revealed specific parameter ranges that are favorable for long-term desynchronization. For instance, RVS CR stimulation at weak intensities and with stimulation frequencies in the range of the neuronal firing rates turned out to be effective and robust, in particular, if no closed loop adaptation of stimulation parameters is (technically) available. From a clinical standpoint, this may be relevant in the context of both invasive as well as non-invasive CR stimulation.

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“…permanent electrical high-frequency pulse train stimulation delivered to dedicated target areas through implanted depth electrodes, used for the treatment of, e.g., Parkinson’s disease [80–82] may cause side effects. If side effects are caused by stimulation of non-target tissue, they may be reduced by adapting the spatial extent of the current spread to the target’s anatomical borders by appropriate electrode designs as introduced, e.g., by [83–85], in particular, to spatially tailor stimuli by means of directional DBS [86–91]. However, some side effects may at least partly be caused by stimulating the target region itself [92, 93].…”

Section: Introductionmentioning

confidence: 99%

How stimulation frequency and intensity impact on the long-lasting effects of coordinated reset stimulation

Manos

Zeitler²,

Tass

2017

Preprint

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374 Modeling the Effects of Current Steering With Directional Leads

Cited by 3 publications

References 0 publications

Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor Increases Therapeutic Window

Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor Increases Therapeutic Window

How stimulation frequency and intensity impact on the long-lasting effects of coordinated reset stimulation

How stimulation frequency and intensity impact on the long-lasting effects of coordinated reset stimulation

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