Clinical deep brain stimulation strategies for orientation-selective pathway activation

Slopsema, Julia P.; Peña, Edgar Carlos Quispe; Patriat, Rémi; Lehto, Lauri J.; Gröhn, Olli; Mangia, Silvia; Harel, Noam; Michaeli, Shalom; Johnson, Matthew D.

doi:10.1088/1741-2552/aad978

Cited by 48 publications

(44 citation statements)

References 64 publications

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“…The direct bounding VTA method used here therefore resulted in VTAs that were larger at the anode than previously reported. There was evidence that previously reported method likely underestimated the activations near the anode (Slopsema et al, 2018;Anderson et al, 2019;Duffley et al, 2019), therefore, the method used here that incorporates multiple orientations orthogonal to the lead offered a more directly interpretable VTA activation profile, especially for a larger target such as the globus pallidus, and especially with a lead with larger vertical spacing (1.5 mm). However, a bigger VTA produced by bipolar stimulations does not directly translate to better therapy or equate with lower side effect threshold-the shape of the VTA matters more in terms of overlapping with therapy regions and side effect pathway activations.…”

Section: Limitations Of Bipolar Vtamentioning

confidence: 86%

“…This is different from the “center node remapping” method, where the APIs were remapped to the center node of the activated axons. The two methods did not differ significantly for cathodal stimulation, as the API tend to be the node that is closest to the cathode (Anderson et al, 2019 ), but because of the virtual cathode effect, the axons near the anode tend to initiate APIs that are further toward the distal ends, rather than the node that is closest to the anode (Slopsema et al, 2018 ; Anderson et al, 2019 ). The direct bounding VTA method used here therefore resulted in VTAs that were larger at the anode than previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…Axonal fiber orientation also matters for bipolar stim (Slopsema et al, 2018 ; Anderson et al, 2019 ). The axonal grid used in this study contained axons that were perpendicular to the DBS lead, but in the GP, there are fibers that run parallel to the lead, and future simlations should certainly include parallel fibers in the model.…”

Section: Discussionmentioning

confidence: 99%

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Steering the Volume of Tissue Activated With a Directional Deep Brain Stimulation Lead in the Globus Pallidus Pars Interna: A Modeling Study With Heterogeneous Tissue Properties

Zhang

Tagliati

Pouratian

et al. 2020

Front. Comput. Neurosci.

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Objective: To study the effect of directional deep brain stimulation (DBS) electrode configuration and vertical electrode spacing on the volume of tissue activated (VTA) in the globus pallidus, pars interna (GPi). Background: Directional DBS leads may allow clinicians to precisely direct current fields to different functional networks within traditionally targeted brain areas. Modeling the shape and size of the VTA for various monopolar or bipolar configurations can inform clinical programming strategies for GPi DBS. However, many computational models of VTA are limited by assuming tissue homogeneity. Methods: We generated a multimodal image-based detailed anatomical (MIDA) computational model with a directional DBS lead (1.5 mm or 0.5 mm vertical electrode spacing) placed with segmented contact 2 at the ventral posterolateral "sensorimotor" region of the GPi. The effect of tissue heterogeneity was examined by replacing the MIDA tissues with a homogeneous tissue of conductance 0.3 S/m. DBS pulses (amplitude: 1 mA, pulse width: 60 µs, frequency: 130 Hz) were used to produce VTAs. The following DBS contact configurations were tested: single-segment monopole (2B-/Case+), two-segment monopole (2A-/2B-/Case+ and 2B-/3B-/Case+), ring monopole (2A-/2B-/2C-/Case+), one-cathode three-anode bipole (2B-/3A+/3B+/3C+), three-cathode three-anode bipole (2A-/2B-/2C-/3A+/3B+/3C+). Additionally, certain vertical configurations were repeated with 2 mA current amplitude. Results: Using a heterogeneous tissue model affected both the size and shape of the VTA in GPi. Electrodes with both 0.5 mm and 1.5 mm vertical spacing (1 mA) modeling showed that the single segment monopolar VTA was entirely contained within the GPi when the active electrode is placed at the posterolateral "sensorimotor" GPi. Two segments in a same ring and ring settings, however, produced VTAs outside of the GPi Zhang et al. Heterogeneous VTA Modeling in GPi border that spread into adjacent white matter pathways, e.g., optic tract and internal capsule. Both stacked monopolar settings and vertical bipolar settings allowed activation of structures dorsal to the GPi in addition to the GPi. Modeling of the stacked monopolar settings with the DBS lead with 0.5 mm vertical electrode spacing further restricted VTAs within the GPi, but the VTA volumes were smaller compared to the equivalent settings of 1.5 mm spacing.

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Section: Limitations Of Bipolar Vtamentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Steering the Volume of Tissue Activated With a Directional Deep Brain Stimulation Lead in the Globus Pallidus Pars Interna: A Modeling Study With Heterogeneous Tissue Properties

Zhang

Tagliati

Pouratian

et al. 2020

Front. Comput. Neurosci.

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“…Here, anodal DBS preferentially activated axons perpendicular to the lead, while at the same time reducing activation of axons parallel to the lead . Bipolar directional stimulation with a system capable of multiple independent current control might even allow for specific current steering to maximize alignment of the electric field with the targeted pathways . This could explain how bipolar DBS helps to avoid side effects caused by, for example, stimulation spread into the internal capsule that runs approximately parallel to the lead in VIMDBS.…”

Section: Discussionmentioning

confidence: 99%

Bipolar Directional Deep Brain Stimulation in Essential and Parkinsonian Tremor

Steffen

Reker

Mennicken

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objective To compare directional monopolar, bipolar, and directional bipolar thalamic deep brain stimulation (DBS) in tremor patients. Methods Fourteen tremor patients (7 Essential Tremor and 7 Parkinson's Disease) implanted with directional DBS electrodes in the ventral intermediate nucleus (VIM) were enrolled. Side‐effect thresholds of monopolar directional stimulation (DIRECT) were compared to circular DBS as well as, in a randomized design, to those of two different bipolar stimulation settings (BIPOLAR = circular anode; BI‐DIRECT = directional anode). Tremor suppression (Tremor Rating Scale, TRS) right below the side‐effect threshold was also assessed. Results Directional DBS in the individually best direction showed higher side‐effect thresholds than circular DBS (p = 0.0063). The thresholds were raised further using either one of the bipolar stimulation paradigms (BIPOLAR p = 0.0029, BI‐DIRECT p = 0.0022). The side‐effect thresholds did not differ between both bipolar settings, but side‐effects were less frequent with BI‐DIRECT. No difference in TRS scores with stimulation just below the side‐effect threshold was found between all stimulation conditions. Conclusions Side‐effect thresholds of monopolar directional and bipolar stimulation with both circular and directional anodes were higher compared to traditional monopolar circular stimulation in the VIM. Bipolar DBS with directional anodes evoked side‐effect less frequently than bipolar and monopolar directional stimulation. All stimulation settings had comparable effects on tremor suppression just below their side‐effect thresholds. Thus, directional and different bipolar settings should be explored in patients with bothersome side‐effects of thalamic stimulation when monopolar stimulation settings are not satisfying. Further studies are needed to explore the efficiency of the different bipolar stimulation paradigms.

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“…Then, FastField scales the pre-computed e-field by the weighted activation amplitude of the corresponding contact and by the user-defined brain conductivity. Finally, it computes the total e-field E ( g ) by exploiting the additive property of electric fields (in line with Anderson et al (2018); Slopsema et al (2018)). Formally, E ( g ) is computed at each point g of the 3D grid as: …”

Section: Methodsmentioning

confidence: 99%

FastField: An Open-Source Toolbox for Efficient Approximation of Deep Brain Stimulation Electric Fields

Baniasadi

Proverbio

Gonçalves

et al. 2020

Preprint

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Deep brain stimulation (DBS) is a surgical therapy to alleviate symptoms of certain brain disorders by electrically modulating neural tissues. Computational models predicting electric fields and volumes of tissue activated are key for efficient parameter tuning and network analysis. Currently, we lack efficient and flexible software implementations supporting complex electrode geometries and stimulation settings. Available tools are either too slow (e.g. finite element method-FEM), or too simple, with limited applicability to basic use-cases. This paper introduces FastField, an efficient open-source toolbox for DBS electric field and VTA approximations. It computes scalable e-field approximations based on the principle of superposition, and VTA activation models from pulse width and axon diameter. In benchmarks and case studies, FastField is solved in about 0.2s, ∼ 1000 times faster than using FEM. Moreover, it is almost as accurate as using FEM: average Dice overlap of 92%, which is around typical noise levels found in clinical data. Hence, FastField has the potential to foster efficient optimization studies and to support clinical applications.

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Clinical deep brain stimulation strategies for orientation-selective pathway activation

Cited by 48 publications

References 64 publications

Steering the Volume of Tissue Activated With a Directional Deep Brain Stimulation Lead in the Globus Pallidus Pars Interna: A Modeling Study With Heterogeneous Tissue Properties

Steering the Volume of Tissue Activated With a Directional Deep Brain Stimulation Lead in the Globus Pallidus Pars Interna: A Modeling Study With Heterogeneous Tissue Properties

Bipolar Directional Deep Brain Stimulation in Essential and Parkinsonian Tremor

FastField: An Open-Source Toolbox for Efficient Approximation of Deep Brain Stimulation Electric Fields

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