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Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes – A Simulation Study
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering. (MINT)ORCID iD: 0000-0002-6896-1452
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology. University of Applied Sciences and Arts Northwestern Switzerland. (MINT)
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering. (MINT)ORCID iD: 0000-0002-0012-7867
2015 (English)In: Brain Disorders and Therapy, ISSN 2168-975X, Vol. 4, no 3, article id 1000169Article in journal (Refereed) Published
Abstract [en]

Background: Deep brain stimulation (DBS) systems in current mode and new lead designs are recently available. To switch between DBS-systems remains complicated as clinicians may lose their reference for programming. Simulations can help increase the understanding.

Objective: To quantitatively investigate the electric field (EF) around two lead designs simulated to operate in voltage and current mode under two time points following implantation.

Methods: The finite element method was used to model Lead 3389 (Medtronic) and 6148 (St Jude) with homogenous surrounding grey matter and a peri-electrode space (PES) of 250 μm. The PES-impedance mimicked the acute (extracellular fluid) and chronic (fibrous tissue) time-point. Simulations at different amplitudes of voltage and current (n=236) were performed using two different contacts. Equivalent current amplitudes were extracted by matching the shape and maximum EF of the 0.2 V/mm isolevel.

Results: The maximum EF extension at 0.2 V/mm varied between 2-5 mm with a small difference between the leads. In voltage mode EF increased about 1 mm at acute compared to the chronic PES. Current mode presented the opposite relationship. Equivalent EFs for lead 3389 at 3 V were found for 7 mA (acute) and 2.2 mA (chronic).

Conclusions: Simulations showed a major impact on the electric field extension between postoperative time points. This may explain the clinical decisions to reprogram the amplitude weeks after implantation. Neither the EF extension nor intensity is considerably influenced by the lead design.

Place, publisher, year, edition, pages
Los Angeles, CA, USA: Omics Publishing Group , 2015. Vol. 4, no 3, article id 1000169
Keywords [en]
deep brain stimulation (DBS), voltage and current stimulation, finite element method
National Category
Other Electrical Engineering, Electronic Engineering, Information Engineering
Identifiers
URN: urn:nbn:se:liu:diva-120680DOI: 10.4172/2168-975X.1000169OAI: oai:DiVA.org:liu-120680DiVA, id: diva2:847766
Funder
Swedish Research Council, 621-2013-6078Available from: 2015-08-21 Created: 2015-08-20 Last updated: 2018-09-10Bibliographically approved
In thesis
1. Models and Simulations of the Electric Field in Deep Brain Stimulation: Comparison of Lead Designs, Operating Modes and Tissue Conductivity
Open this publication in new window or tab >>Models and Simulations of the Electric Field in Deep Brain Stimulation: Comparison of Lead Designs, Operating Modes and Tissue Conductivity
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Deep brain stimulation (DBS) is an established surgical therapy for movement disorders such as Parkinson’s disease (PD) and essential tremor (ET). A thin electrode is implanted in a predefined area of the brain with the use of stereotactic neurosurgery. In the last few years new DBS electrodes and systems have been developed with possibilities for using more parameters for control of the stimulation volume.

In this thesis, simulations using the finite element method (FEM) have been developed and used for investigation of the electric field (EF) extension around different types of DBS lead designs (symmetric, steering) and stimulation modes (voltage, current). The electrode surrounding was represented either with a homogeneous model or a patient-specific model based on individual preoperative magnetic resonance imaging (MRI). The EF was visualized and compared for different lead designs and operating modes.

In Paper I, the EF was quantitatively investigated around two lead designs (3389 and 6148) simulated to operate in voltage and current mode under acute and chronic time points following implantation.Simulations showed a major impact on the EF extension between postoperative time points which may explain the clinical decisions to change the stimulation amplitude weeks after implantation. In Paper II, the simulations were expanded to include two leads having steering function (6180, Surestim1) and patient-specific FEM simulations in the zona incerta. It was found that both the heterogeneity of the tissue and the operating mode, influence the EF distribution and that equivalent contact configurations of the leads result in similar EF. The steering mode presented larger volumes in current mode when using equivalent amplitudes. Simulations comparing DBS and intraoperative stimulation test using a microelectrode recording (MER) system (Paper III), showed that several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution and that the DBS EF volume can cover, but also extend to, other anatomical areas.

Paper IV introduces a method for an objective exploitation of intraoperative stimulation test data in order to identify the optimal implant position in the thalamus of the chronic DBS lead. Patient-specific EF simulations were related to the anatomy with the help of brain atlases and the clinical effects which were quantified by accelerometers. The first results indicate that the good clinical effect in ET is due to several structures around the ventral intermediate nucleus of the thalamus.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 99
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1945
National Category
Other Medical Engineering
Identifiers
urn:nbn:se:liu:diva-150996 (URN)10.3384/diss.diva-150996 (DOI)9789176852613 (ISBN)
Public defence
2018-09-14, Grannitsalen, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2018-09-10 Created: 2018-09-10 Last updated: 2018-09-10Bibliographically approved

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Alonso, FabiolaHemm-Ode, SimoneWårdell, Karin

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