Original ArticleCurrent steering to activate targeted neural pathways during deep brain stimulation of the subthalamic region
Section snippets
Materials and methods
Predictions of neural activation in response to DBS were performed using a detailed computational model of STN DBS that included three major components: (1) three-dimensional representation of the DBS electrode within the subthalamic nucleus, (2) three-dimensional reconstructions of STN, GPi, and IC populations, and (3) finite element models of the electric fields generated by a wide range of stimulation settings. The number of active cathodic and/or anodic contacts, as well as the current
Results
This study was undertaken with the basic assumption that optimal therapeutic benefit from DBS is achieved when activation of target neural populations is maximized, and the activation of side effect neural populations is minimized. Within the context of this theoretical study, our target neural population was composed of STN projection neurons and GPi fibers of passage. The IC fibers of passage were defined as the deleterious side effect neural population. Our results outline the impact of
Discussion
The goal of this study was to evaluate the ability of current steering technology to improve DBS activation selectivity in targeted neural populations. We used a highly detailed electric field model coupled to three-dimensional neuron models with anatomically realistic geometries and membrane dynamics. We focused on activation of three different neural populations (STN projection neurons, GPi fibers of the lenticular fasciculus, and IC fibers of passage), and quantified their activation by
Conclusion
Although typical clinical practice with traditional DBS technology tends to focus on monopolar stimulation, we found that DBS devices capable of current steering between contacts opens up additional opportunities to achieve an improved balance between activation of target and side effect neural populations. This study demonstrated that increased selective activation was possible by using a current-controlled device with independent sources. Future studies are needed to explicitly define the
References (34)
- et al.
Current steering to control the volume of tissue activated during deep brain stimulation
Brain Stimulat
(2008) - et al.
Patient-specific analysis of the volume of tissue activated during deep brain stimulation
NeuroImage
(2007) - et al.
Electric field and stimulating influence generated by deep brain stimulation of the subthalamic nucleus
Clin Neurophysiol
(2004) - et al.
The pallidofugal motor fiber system in primates
Parkinsonism Relat Disord
(2004) - et al.
Patient-specific models of deep brain stimulation: Influence of field model complexity on neural activation predictions
Brain Stimulat
(2010) - et al.
Excitation of central nervous system neurons by nonuniform electric fields
Biophys J
(1999) - et al.
Dissociation of motor symptoms during deep brain stimulation of the subthalamic nucleus in the region of the internal capsule
Exp Neurol
(2011) - et al.
Electrical stimulation of excitable tissue: design of efficacious and safe protocols
J Neurosci Methods
(2005) - et al.
Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease
N Engl J Med
(2001) - Weaver FM, Follett K, Stern M, et al. Bilateral deep brain stimulation vs best medical therapy for patients with...
Reversing cognitive-motor impairments in Parkinson’s disease patients using a computational modelling approach to deep brain stimulation programming
Brain
Assessment of brain shift related to deep brain stimulation surgery
Stereotact Funct Neurosurg
Effect of brain shift on the creation of functional atlases for deep brain stimulation surgery
Int J Comput Assist Radiol Surg
Deep brain stimulation in dystonia: sonographic monitoring of electrode placement into the globus pallidus internus
Mov Disord
The first evaluation of brain shift during functional neurosurgery by deformation field analysis
J Neurol Neurosurg Psychiatry
Intraoperative X-ray detection and MRI-based quantification of brain shift effects subsequent to implantation of the first electrode in bilateral implantation of deep brain stimulation electrodes
Stereotact Funct Neurosurg
Current-controlled deep brain stimulation reduces in vivo voltage fluctuations observed during voltage-controlled stimulation
Clin Neurophysiol
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2020, NeuronCitation Excerpt :In this context, the idea of spatiotemporally “sweeping” a current stimulus across the primary visual cortex in blind individuals has been promoted by Yoshor and colleagues; the patients appear to report visual perception of elemental, phosphene-intermediated patterns of perception (Beauchamp et al., 2020). Compounding the challenges in delivering multi-point focused electrical stimulation by principles of rational design yet to be discovered, there appears to be some ambiguity in recent literature about the notion of “current steering,” which has been proposed to improve the focality of the current injection (e.g., Chaturvedi et al., 2012). While the use of bipolar stimulation, particularly from small electrodes, can allow for focal stimulation, precision control of pathways of current flow is overall a challenge, given that current spreads in any reasonably conductive medium.
Orientation selective deep brain stimulation of the subthalamic nucleus in rats
2020, NeuroImageCitation Excerpt :Given a more advanced lead design with a larger channel count in three dimensions, it may be possible to perform selective stimulation of various fiber tracts emanating from or impinging on the STN. It has been shown by earlier modeling studies that, compared to bipolar current steering, monopolar two- electrode current steering may stimulate a greater fraction of the STN projection neurons simultaneously with axons of the internal globus pallidus (Chaturvedi et al., 2012) while avoiding the axons of the internal capsule. On the other hand, the same authors showed that unbalanced bipolar current steering may be able to stimulate a greater fraction of only STN projection neurons in comparison to monopolar current steering (Chaturvedi et al., 2012).
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This work was supported by the National Institutes of Health (R01 NS059736) and Boston Scientific Neuromodulation Corporation.
Paid consultancy for A.C. and C.C.M. (Intelect Medical Inc.); A.C., T.J.F., and C.C.M. (Boston Scientific Neuromodulation Corp.)