Directional Deep Brain Stimulation: First experiences in centers across the globe

Brinke, Timo R. ten; Odekerken, Vincent J.J.; Dijk, J. Marc C. van; Munckhof, Pepijn van den; Schuurman, P.R.; Bie, Rob M.A. de

doi:10.1016/j.brs.2018.04.008

Cited by 31 publications

(31 citation statements)

References 5 publications

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“…Current fractionalization is defined as distributing currents through two or more electrodes. While allowing for high level of user control of the activated tissue, current fractionalization also increases the complexity of programming and may reduce the implantable pulse generator (IPG) lifespan.…”

Section: Introductionmentioning

confidence: 99%

Comparing Current Steering Technologies for Directional Deep Brain Stimulation Using a Computational Model That Incorporates Heterogeneous Tissue Properties

Zhang

Silburn

Pouratian

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objective A computational model that accounts for heterogeneous tissue properties was used to compare multiple independent current control (MICC), multi‐stim set (MSS), and concurrent activation (co‐activation) current steering technologies utilized in deep brain stimulation (DBS) on volume of tissue activated (VTA) and power consumption. Methods A computational model was implemented in Sim4Life v4.0 with the multimodal image‐based detailed anatomical (MIDA) model, which accounts for heterogeneous tissue properties. A segmented DBS lead placed in the subthalamic nucleus (STN). Three milliamperes of current (with a 90 μs pseudo‐biphasic waveform) was distributed between two electrodes with various current splits. The laterality, directional accuracy, volume, and shape of the VTAs using MICC, MSS and co‐activation, and their power consumption were computed and compared. Results MICC, MSS, and coactivation resulted in less laterality of steering than single‐segment activation. Both MICC and MSS show directional inaccuracy (more pronounced with MSS) during radial current steering. Co‐activation showed greater directional accuracy than MICC and MSS at centerline between the two activated electrodes. MSS VTA volume was smaller and more compact with less current spread outside the active electrode plane than MICC VTA. There was no consistent pattern of power drain between MSS and MICC, but electrode co‐activation always used less power than either fractionating paradigm. Conclusion While current fractionalization technologies can achieve current steering between two segmented electrodes, this study shows that there are important limitations in accuracy and focus of tissue activation when tissue heterogeneity is accounted for.

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Section: Introductionmentioning

confidence: 99%

Comparing Current Steering Technologies for Directional Deep Brain Stimulation Using a Computational Model That Incorporates Heterogeneous Tissue Properties

Zhang

Silburn

Pouratian

et al. 2020

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

show abstract

“…Research is also needed to compare the outcomes of awake and asleep surgery in a randomized study. Directional and segmental stimulation, which is thought to increase adverse-event thresholds, 96,97 also remains to be more thoroughly investigated. Most importantly, large multicenter databases will probably be needed to more accurately predict for whom and when what type of DBS is appropriate.…”

Section: Resultsmentioning

confidence: 99%

Deep-brain stimulation for Parkinson's disease: current perspectives on patient selection with an emphasis on neuropsychology

Tröster¹,

Ponce²,

Moguel‐Cobos³

2018

JPRLS

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For some persons with Parkinson's disease, deep-brain stimulation (DBS) is an effective treatment that enhances function and quality of life. It is critical that the preoperative evaluation process yields information that allows the treatment team to determine the likelihood that DBS (directed at a specific target) will be an effective and safe treatment for a given person and that the treatment will meet that person's goals and expectations. Such information allows the team and the patient to perform a cost-benefit analysis and the patient and family to make an informed decision about the potential appropriateness of DBS, and ultimately whether or not to undergo DBS or alternative treatments. We review the multidisciplinary DBS evaluation and education process in general (and by exemplar at Barrow Neurological Institute) engaging the patient with neurology, neuropsychology, neurosurgery, neuroscience nursing, and when needed, psychiatry, social work, and additional medical subspecialties. The review first covers screening, including two standardized instruments, and then the more detailed preoperative evaluation that ensues after screening. Neuropsychological issues in patient selection, and especially cognition, are emphasized, because they remain the most controversial and yet often underlie the judgment that DBS is not an appropriate treatment for a given patient. Outcome studies, perhaps via large, multisite patient registries, are needed to identify neuropsychological risks for unsatisfactory outcome and to define better which surgery (e.g., target, side, timing) is best for a given patient. Such studies would ultimately allow one to judge whether current selection criteria are adequate, need to be stricter, or can be relaxed, and, consequently ensure that the therapy is accessible to the maximum number of persons who will benefit from it without significant adverse effects.

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“…The use of simple programming protocols, such as the activation of a single directional segment, has proved to be effective in the vast majority of cases [13]. Directional multiple-electrode programming configurations, whether using independent current controllers or interleaving, may provide additional nuances in programming strategies, but may also result in increased programming complexity [59], changes to battery power consumption, and reduction in the laterality of the volume of activation [60]. To assist with DBS programming, DBS producers developed innovative software platforms for functional mapping, as well as tools for visualization of the volume of neural activation.…”

Section: Discussionmentioning

confidence: 99%

Current Directions in Deep Brain Stimulation for Parkinson’s Disease—Directing Current to Maximize Clinical Benefit

et al. 2020

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Several single-center studies and one large multicenter clinical trial demonstrated that directional deep brain stimulation (DBS) could optimize the volume of tissue activated (VTA) based on the individual placement of the lead in relation to the target. The ability to generate axially asymmetric fields of stimulation translates into a broader therapeutic window (TW) compared to conventional DBS. However, Aristide Merola and Alberto Romagnolo contributed equally to the manuscript and shared co-first authorship. Enhanced digital features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11864961.

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Directional Deep Brain Stimulation: First experiences in centers across the globe

Cited by 31 publications

References 5 publications

Comparing Current Steering Technologies for Directional Deep Brain Stimulation Using a Computational Model That Incorporates Heterogeneous Tissue Properties

Comparing Current Steering Technologies for Directional Deep Brain Stimulation Using a Computational Model That Incorporates Heterogeneous Tissue Properties

Deep-brain stimulation for Parkinson's disease: current perspectives on patient selection with an emphasis on neuropsychology

Current Directions in Deep Brain Stimulation for Parkinson’s Disease—Directing Current to Maximize Clinical Benefit

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Directional Deep Brain Stimulation: First experiences in centers across the globe

Cited by 31 publications

References 5 publications

Comparing Current Steering Technologies for Directional Deep Brain Stimulation Using a Computational Model That Incorporates Heterogeneous Tissue Properties

Comparing Current Steering Technologies for Directional Deep Brain Stimulation Using a Computational Model That Incorporates Heterogeneous Tissue Properties

Deep-brain stimulation for Parkinson&#39;s disease: current perspectives on patient selection with an emphasis on neuropsychology

Current Directions in Deep Brain Stimulation for Parkinson’s Disease—Directing Current to Maximize Clinical Benefit

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Deep-brain stimulation for Parkinson's disease: current perspectives on patient selection with an emphasis on neuropsychology