Analysis of patient-specific stimulation with segmented leads in the subthalamic nucleus.

Nguyen, T. A. Khoa; Djilas, Milan; Nowacki, Andreas; Mercanzini, André; Schüpbach, Michael; Renaud, Philipp; Pollo, Claudio (2019). Analysis of patient-specific stimulation with segmented leads in the subthalamic nucleus. PLoS ONE, 14(6), e0217985. Public Library of Science 10.1371/journal.pone.0217985

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OBJECTIVE Segmented deep brain stimulation leads in the subthalamic nucleus have shown to increase therapeutic window using directional stimulation. However, it is not fully understood how these segmented leads with reduced electrode size modify the volume of tissue activated (VTA) and how this in turn relates with clinically observed therapeutic and side effect currents. Here, we investigated the differences between directional and omnidirectional stimulation and associated VTAs with patient-specific therapeutic and side effect currents for the two stimulation modes. APPROACH Nine patients with Parkinson's disease underwent DBS implantation in the subthalamic nucleus. Therapeutic and side effect currents were identified intraoperatively with a segmented lead using directional and omnidirectional stimulation (these current thresholds were assessed in a blinded fashion). The electric field around the lead was simulated with a finite-element model for a range of stimulation currents for both stimulation modes. VTAs were estimated from the electric field by numerical differentiation and thresholding. Then for each patient, the VTAs for given therapeutic and side effect currents were projected onto the patient-specific subthalamic nucleus and lead position. RESULTS Stimulation with segmented leads with reduced electrode size was associated with a significant reduction of VTA and a significant increase of radial distance in the best direction of stimulation. While beneficial effects were associated with activation volumes confined within the anatomical boundaries of the subthalamic nucleus at therapeutic currents, side effects were associated with activation volumes spreading beyond the nucleus' boundaries. SIGNIFICANCE The clinical benefits of segmented leads are likely to be obtained by a VTA confined within the subthalamic nucleus and a larger radial distance in the best stimulation direction, while steering the VTA away from unwanted fiber tracts outside the nucleus. Applying the same concepts at a larger scale and in chronically implanted patients may help to predict the best stimulation area.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Nguyen, Thuy Anh Khoa; Nowacki, Andreas; Schüpbach, Michael and Pollo, Claudio

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Nicole Söll

Date Deposited:

09 Aug 2019 15:49

Last Modified:

22 Oct 2019 22:05

Publisher DOI:

10.1371/journal.pone.0217985

PubMed ID:

31216311

BORIS DOI:

10.7892/boris.132397

URI:

https://boris.unibe.ch/id/eprint/132397

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