liu.seSearch for publications in DiVA
Change search
Refine search result
1 - 18 of 18
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Modeling and simulation of DBS – comparison between leads and stimulation modes2014Conference paper (Other academic)
  • 2.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Models and Simulations of the Electric Field in Deep Brain Stimulation: Comparison of Lead Designs, Operating Modes and Tissue Conductivity2018Doctoral 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.

    List of papers
    1. Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes – A Simulation Study
    Open this publication in new window or tab >>Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes – A Simulation Study
    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
    Keywords
    deep brain stimulation (DBS), voltage and current stimulation, finite element method
    National Category
    Other Electrical Engineering, Electronic Engineering, Information Engineering
    Identifiers
    urn:nbn:se:liu:diva-120680 (URN)10.4172/2168-975X.1000169 (DOI)
    Funder
    Swedish Research Council, 621-2013-6078
    Available from: 2015-08-21 Created: 2015-08-20 Last updated: 2018-09-10Bibliographically approved
    2. Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study
    Open this publication in new window or tab >>Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study
    Show others...
    2016 (English)In: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 6, no 3, p. 1-16Article in journal (Refereed) Published
    Abstract [en]

    New deep brain stimulation (DBS) electrode designs offer operation in voltage and current mode and capability to steer the electric field (EF). The aim of the study was to compare the EF distributions of four DBS leads at equivalent amplitudes (3 V and 3.4 mA). Finite element method (FEM) simulations (n = 38) around cylindrical contacts (leads 3389, 6148) or equivalent contact configurations (leads 6180, SureStim1) were performed using homogeneous and patient-specific (heterogeneous) brain tissue models. Steering effects of 6180 and SureStim1 were compared with symmetric stimulation fields. To make relative comparisons between simulations, an EF isolevel of 0.2 V/mm was chosen based on neuron model simulations (n = 832) applied before EF visualization and comparisons. The simulations show that the EF distribution is largely influenced by the heterogeneity of the tissue, and the operating mode. Equivalent contact configurations result in similar EF distributions. In steering configurations, larger EF volumes were achieved in current mode using equivalent amplitudes. The methodology was demonstrated in a patient-specific simulation around the zona incerta and a “virtual” ventral intermediate nucleus target. In conclusion, lead design differences are enhanced when using patient-specific tissue models and current stimulation mode.

    Place, publisher, year, edition, pages
    MDPI, 2016
    Keywords
    deep brain stimulation (DBS), steering, patient-specific, electric field, finite element method, neuron model, brain model, zona incerta (ZI), electrode design
    National Category
    Medical Engineering
    Identifiers
    urn:nbn:se:liu:diva-131863 (URN)10.3390/brainsci6030039 (DOI)27618109 (PubMedID)
    Available from: 2016-10-11 Created: 2016-10-11 Last updated: 2018-09-10Bibliographically approved
    3. Electric Field Comparison between Microelectrode Recording and Deep Brain Stimulation Systems: A Simulation Study
    Open this publication in new window or tab >>Electric Field Comparison between Microelectrode Recording and Deep Brain Stimulation Systems: A Simulation Study
    Show others...
    2018 (English)In: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 8, no 2Article in journal (Refereed) Published
    Abstract [en]

    The success of deep brain stimulation (DBS) relies primarily on the localization of the implanted electrode. Its final position can be chosen based on the results of intraoperative microelectrode recording (MER) and stimulation tests. The optimal position often differs from the final one selected for chronic stimulation with the DBS electrode. The aim of the study was to investigate, using finite element method (FEM) modeling and simulations, whether lead design, electrical setup, and operating modes induce differences in electric field (EF) distribution and in consequence, the clinical outcome. Finite element models of a MER system and a chronic DBS lead were developed. Simulations of the EF were performed for homogenous and patient-specific brain models to evaluate the influence of grounding (guide tube vs. stimulator case), parallel MER leads, and non-active DBS contacts. Results showed that the EF is deformed depending on the distance between the guide tube and stimulating contact. Several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution. The DBS EF volume can cover the intraoperatively produced EF, but can also extend to other anatomical areas. In conclusion, EF deformations between stimulation tests and DBS should be taken into consideration as they can alter the clinical outcome

    Place, publisher, year, edition, pages
    MDPI, 2018
    Keywords
    microelectrode recording (MER); finite element method (FEM); deep brain stimulation (DBS); brain model; Dice coefficient; patient-specific
    National Category
    Medical Engineering
    Identifiers
    urn:nbn:se:liu:diva-145112 (URN)10.3390/brainsci8020028 (DOI)
    Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-09-10
    4. Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus
    Open this publication in new window or tab >>Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus
    Show others...
    2016 (English)In: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 10, p. 1-14, article id 577Article in journal (Refereed) Published
    Abstract [en]

    Despite an increasing use of deep brain stimulation (DBS) the fundamental mechanisms of action remain largely unknown. Simulation of electric entities has previously been proposed for chronic DBS combined with subjective symptom evaluations, but not for intraoperative stimulation tests. The present paper introduces a method for an objective exploitation of intraoperative stimulation test data to identify the optimal implant position of the chronic DBS lead by relating the electric field (EF) simulations to the patient-specific anatomy and the clinical effects quantified by accelerometry. To illustrate the feasibility of this approach, it was applied to five patients with essential tremor bilaterally implanted in the ventral intermediate nucleus (VIM). The VIM and its neighborhood structures were preoperatively outlined in 3D on white matter attenuated inversion recovery MR images. Quantitative intraoperative clinical assessments were performed using accelerometry. EF simulations (n = 272) for intraoperative stimulation test data performed along two trajectories per side were set-up using the finite element method for 143 stimulation test positions. The resulting EF isosurface of 0.2 V/mm was superimposed to the outlined anatomical structures. The percentage of volume of each structure’s overlap was calculated and related to the corresponding clinical improvement. The proposed concept has been successfully applied to the five patients. For higher clinical improvements, not only the VIM but as well other neighboring structures were covered by the EF isosurfaces. The percentage of the volumes of the VIM, of the nucleus intermediate lateral of the thalamus and the prelemniscal radiations within the prerubral field of Forel increased for clinical improvements higher than 50% compared to improvements lower than 50%. The presented new concept allows a detailed and objective analysis of a high amount of intraoperative data to identify the optimal stimulation target. First results indicate agreement with published data hypothesizing that the stimulation of other structures than the VIM might be responsible for good clinical effects in essential tremor. (Clinical trial reference number: Ref: 2011-A00774-37/AU905)

    Place, publisher, year, edition, pages
    Frontiers Research Foundation, 2016
    Keywords
    deep brain stimulation (DBS), intraoperative stimulation tests, essential tremor, acceleration measurements, finite element method (FEM) simulations, ventral intermediate nucleus (VIM), patient-specific brain maps
    National Category
    Medical Engineering
    Identifiers
    urn:nbn:se:liu:diva-132790 (URN)10.3389/fnhum.2016.00577 (DOI)000388426400001 ()
    Available from: 2016-11-25 Created: 2016-11-25 Last updated: 2018-09-10Bibliographically approved
  • 3.
    Alonso, Fabiola
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Hemm-Ode, Simone
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology. University of Applied Sciences and Arts Northwestern Switzerland.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes – A Simulation Study2015In: Brain Disorders and Therapy, ISSN 2168-975X, Vol. 4, no 3, article id 1000169Article in journal (Refereed)
    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.

  • 4.
    Alonso, Fabiola
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Latorre, Malcolm
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Göransson, Nathanael
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Zsigmond, Peter
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Wårdell, karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study2016In: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 6, no 3, p. 1-16Article in journal (Refereed)
    Abstract [en]

    New deep brain stimulation (DBS) electrode designs offer operation in voltage and current mode and capability to steer the electric field (EF). The aim of the study was to compare the EF distributions of four DBS leads at equivalent amplitudes (3 V and 3.4 mA). Finite element method (FEM) simulations (n = 38) around cylindrical contacts (leads 3389, 6148) or equivalent contact configurations (leads 6180, SureStim1) were performed using homogeneous and patient-specific (heterogeneous) brain tissue models. Steering effects of 6180 and SureStim1 were compared with symmetric stimulation fields. To make relative comparisons between simulations, an EF isolevel of 0.2 V/mm was chosen based on neuron model simulations (n = 832) applied before EF visualization and comparisons. The simulations show that the EF distribution is largely influenced by the heterogeneity of the tissue, and the operating mode. Equivalent contact configurations result in similar EF distributions. In steering configurations, larger EF volumes were achieved in current mode using equivalent amplitudes. The methodology was demonstrated in a patient-specific simulation around the zona incerta and a “virtual” ventral intermediate nucleus target. In conclusion, lead design differences are enhanced when using patient-specific tissue models and current stimulation mode.

  • 5.
    Alonso, Fabiola
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Vogel, Dorian
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. University of Applied Sciences and Arts Northwestern Switzerland FHNW, 4132 Muttenz, Switzerland.
    Johansson, Johannes
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Hemm, Simone
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. rthwestern Switzerland FHNW, 4132 Muttenz, Switzerland.
    Electric Field Comparison between Microelectrode Recording and Deep Brain Stimulation Systems: A Simulation Study2018In: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 8, no 2Article in journal (Refereed)
    Abstract [en]

    The success of deep brain stimulation (DBS) relies primarily on the localization of the implanted electrode. Its final position can be chosen based on the results of intraoperative microelectrode recording (MER) and stimulation tests. The optimal position often differs from the final one selected for chronic stimulation with the DBS electrode. The aim of the study was to investigate, using finite element method (FEM) modeling and simulations, whether lead design, electrical setup, and operating modes induce differences in electric field (EF) distribution and in consequence, the clinical outcome. Finite element models of a MER system and a chronic DBS lead were developed. Simulations of the EF were performed for homogenous and patient-specific brain models to evaluate the influence of grounding (guide tube vs. stimulator case), parallel MER leads, and non-active DBS contacts. Results showed that the EF is deformed depending on the distance between the guide tube and stimulating contact. Several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution. The DBS EF volume can cover the intraoperatively produced EF, but can also extend to other anatomical areas. In conclusion, EF deformations between stimulation tests and DBS should be taken into consideration as they can alter the clinical outcome

  • 6.
    Alonso, Fabiola
    et al.
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Vogel, Dorian
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Hemm-Ode, Simone
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Institute for Medical and Analytical Technologies and Department of Biomedical Engineering, University of Applied Sciences and Art Northwestern Switzerland.
    Comparison between intraoperative and chronic and deep brain stimulation2017Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION

    The success of the deep brain stimulation (DBS) therapy relies primarily in the localization of the implanted electrode, implying the need of utmost accuracy in the targeting process. Intraoperative microelectrode recording and stimulation tests are a common procedure before implanting the permanent DBS lead to determine the optimal position with a large therapeutic window where side effects are avoided and the best improvement of the symptoms is achieved. Differences in dimensions and operating modes exist between the exploration and the permanent DBS electrode which might lead to different stimulation fields, even when ideal placement is achieved. The aim of this investigation is to compare the electric field (EF) distribution around the intraoperative and the chronic electrode, assuming that both have exactly the same position.

    METHODS

    3D models of the intraoperative exploration electrode and the chronically implanted DBS lead 3389 (Medtronic Inc., USA) were developed using COMSOL 5.2 (COMSOL AB, Sweden). Patient-specific MR images were used to determine the conductive medium around the electrode. The exploration electrode and the first DBS contact were set to current and voltage respectively (0.2mA(V) - 3 mA(V) in 0.1 mA(V) steps). The intraoperative model included the grounded guide tube used to introduce the exploration electrode; for the chronic DBS model, the outer boundaries were grounded and the inactive contacts were set to floating potential considering a monopolar configuration. The localization of the exploration and the chronic electrode was set according to the planned trajectory. The EF was visualized and compared in terms of volume and extension using a fixed isocontour of 0.2 V/mm.

    RESULTS

    The EF distribution simulated for the exploration electrode showed the influence of the parallel trajectory and the grounded guide tube. For an amplitude of e.g. 2 mA/2 V, the EF extension of the intraoperative was 0.6 mm larger than the chronic electrode at the target level; the corresponding difference in volume was 76.1 mm3.

    CONCLUSION

    Differences in the EF shape between the exploration and the chronic DBS electrode have been observed using patient-specific models. The larger EF extension obtained for the exploration electrode responds to its higher impedance and the use of current controlled stimulation. The presence of EF around the guide tube and the influence of the parallel trajectory require further experimental and clinical evaluation.

  • 7.
    Alonso, Fabiola
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Comparison of deep brain stimulation systems2014In: Poster Presentations, 2014, Vol. 29, p. 1173-1173, article id Suppl 1Conference paper (Other academic)
    Abstract [en]

    Objective: To quantitatively compare the electric field generated by voltage and current controlled deep brain stimulation systems.

    Background: Traditionally deep brain stimulation (DBS) systems have used voltage control however more recently, current controlled systems have been approved to treat Parkinson's disease and related movement disorders. In the endeavor of understanding the behavior of DBS systems a common approach is the use of computer models suitable to simulate the electric field, current density and other related electric parameters.

    Methods: 2D finite element models based on commercially available DBS systems have been built for each system: I. Model 3389, Medtronic Inc., USA for voltage control; and II. Model 6142, St Jude Medical Inc. USA for current control. The brain tissue has been simplified to homogeneous and isotropic medium. The electric settings correspond to a monopolar configuration, using one of the four contacts available as the active electrode and the outer boundary of the tissue as the reference. Three simulations were performed to mimic different stages of the leads implantation: a) an original stage where the brain tissue is considered as pure gray matter, b) an acute stage that simulates the leakage of cerebral spinal fluid immediately after the electrodes' insertion; and c) a chronic stage mimicking fibrous tissue created around the electrodes some weeks after implantation. Both systems were submitted to the same conditions using as active electrode the third contact from the tip of the lead. The comparison is based on the maximal distance reached by the isopotential of 0.2 V/mm.

    Results: The simulations showed that voltage controlled stimulation systems are more susceptible to changes in the electrical conductivity of the medium i.e. change over time of the tissue around the electrode. This agrees with the adjustment of the stimulation amplitude often necessary a few weeks postoperatively. Current controlled stimulation in turn, presented a linear behavior of the distance reached at different stimulation amplitudes at all stages.

    Conclusions: Current controlled stimulation might be a good option due to its linear behavior over time, nevertheless more studies including a more realistic brain model, different designs of DBS electrodes and different electric parameter, are needed to encourage the use of this type of systems.

  • 8.
    Alonso, Fabiola
    et al.
    Linköping University, Faculty of Science & Engineering. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Electric Field Comparison of Deep Brain Stimulation Lead Designs - a Stimulation Study2016Conference paper (Refereed)
  • 9.
    Alonso, Fabiola
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Latorre, Malcolm
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Comparison of Three Deep Brain Stimulation Lead Designs under Voltage and Current Modes2015In: WORLD CONGRESS ON MEDICAL PHYSICS AND BIOMEDICAL ENGINEERING, 2015, VOLS 1 AND 2 / [ed] David A. Jaffray, Springer, 2015, Vol. 51, p. 1196-1199Conference paper (Refereed)
    Abstract [en]

    Since the introduction of deep brain stimulation (DBS) the technique has been dominated by Medtronic sys-tems. In recent years, new DBS systems have become available for patients, and some are in clinical trials. The present study aims to evaluate three DBS leads operated in either voltage or current mode. 3D finite element method (FEM) models were built in combination with a neuron model for this purpose. The axon diameter was set to D = 5 μm and simulations performed in both voltage (0.5-5 V) and current (0.5-5 mA) mode. The evaluation was achieved based on the distance from the lead for neural activation and the electric field (EF) extension at 0.1 V/mm. The results showed that the neural activation distance agrees well between the leads with an activation distance dif-ference less than 0.5 mm. The shape of the field at the 0.1 V/mm isopotential surface in 3D is mostly spherical in shape around the activated section of the steering lead.

  • 10.
    Alonso, Fabiola
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Latorre, Malcolm
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Neural Activation Compared to Electric Field Extension of Three DBS Lead Designs2015Conference paper (Refereed)
    Abstract [en]

    SINCE the introduction of deep brain stimulation (DBS) about 20 years ago, the stimulation technique has been dominated by Medtronic DBS-system setup. In recent years, new DBS systems have become available, of which some are in clinical trials or available to patients [1]. In the present study three different lead designs are investigated via computer simulation:

    Medtronic 3389, St. Jude 6148 and Sapiens SureStim. The aim was to compare the neural activation distance and the electric field (EF) maximum spatial extension for each lead.

    A 3D finite element method model was built using COMSOL Multiphysics 4.4a (COMSOL AB, Stockholm, Sweden) to simulate the electric potential around the DBS lead. Brain tissue was modelled as a homogeneous volume of grey matter (electric conductivity of 0.09 S/m). The electrode-tissue interface was modelled with a 250μm thick peri-electrode space mimicking the fibrous tissue which covers the lead at the chronic stimulation stage (σ = 0.06S/m, equivalent to white matter electric conductivity). The stimulation amplitude was set to 1V in monopolar configuration using C1 electrode or equivalent in all cases. Each simulated electric potential distribution was exported to MatLab (The MathWorks, USA) and used as input to a cable neuron simulation.

    An axon cable model with 21 nodes based on the concept by Åström et al., [2] was set up in MatLab and combined with the exported field distributions. The model considered a 5 μm thick neuron, a pulse width of 60 μs and a drive potential ranging from 0.5 V to 5 V in 0.5 V steps.

    The SureStim lead results showed a shorter neural activation distance and EF extension. The distance to the isolevel of 0.2 V/mm is close to the neural activation distance at each stimulation amplitude, and we conclude that the electric field is a suitable predictor to visualize the stimulated regions.

  • 11.
    Göransson, Nathanael
    et al.
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Johansson, Johannes
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Zsigmond, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Postoperative lead movement after deep brain stimulation surgery and changes of stimulation area2017Conference paper (Other academic)
    Abstract [en]

    Introduction

    Lead movement after deep brain stimulation (DBS) may occur and influence the area of stimulation. The cause of the displacement is not fully understood. The aim of the study was to investigate differences in lead position between the day after surgery and approximately one month postoperatively and also simulate the electric field (EF) around the active contacts.

    Methods

    23 patients with movement disorders underwent DBS surgery (37 leads). CT at the two time points were co-fused respectively with the stereotactic images in Surgiplan. The coordinates (x, y, z) of the lead tips were compared between the two dates (paired t-test). 8 of these patients were selected for the EF simulation in Comsol Multiphysics.

    Results

    There was a significant discrepancy (mean ± s.d.) on the left lead: x (0.44 ± 0.72, p < 0.01), y (0.64 ± 0.54, p < 0.001), z (0.62 ± 0.71, p < 0.001).  On the right lead, corresponding values were: x (-0.11 ± 0.61, n.s.), y (0.71 ± 0.54, p < 0.001), z (0.49 ± 0.81, p < 0.05).  No correlation was found between bilateral (n =14) vs. unilateral DBS, gender (n = 17 male) and age < 60 years (n = 8).  The lead movement affected the EF spread (Fig. 1).

    Conclusion

    The left lead tip displayed a tendency to move lateral, anterior and inferior and the right a tendency to move anterior and inferior. Lead movement after DBS can be a factor to consider before starting the stimulation. The differences in the area of stimulation might affect clinical outcome.

  • 12.
    Hemm-Ode, Simone
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering. Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland.
    Pison, Daniela
    Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Shah, Ashesh
    Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland.
    Coste, Jérôme
    Université Clermont Auvergne, Université d’Auvergne, EA 7282, Image Guided Clinical Neurosciences and Connectomics (IGCNC), Clermont-Ferrand, France; Service de Neurochirurgie, Hôpital Gabriel-Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
    Lemaire, Jean-Jacques
    Université Clermont Auvergne, Université d’Auvergne, EA 7282, Image Guided Clinical Neurosciences and Connectomics (IGCNC), Clermont-Ferrand, France; Service de Neurochirurgie, Hôpital Gabriel-Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus2016In: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 10, p. 1-14, article id 577Article in journal (Refereed)
    Abstract [en]

    Despite an increasing use of deep brain stimulation (DBS) the fundamental mechanisms of action remain largely unknown. Simulation of electric entities has previously been proposed for chronic DBS combined with subjective symptom evaluations, but not for intraoperative stimulation tests. The present paper introduces a method for an objective exploitation of intraoperative stimulation test data to identify the optimal implant position of the chronic DBS lead by relating the electric field (EF) simulations to the patient-specific anatomy and the clinical effects quantified by accelerometry. To illustrate the feasibility of this approach, it was applied to five patients with essential tremor bilaterally implanted in the ventral intermediate nucleus (VIM). The VIM and its neighborhood structures were preoperatively outlined in 3D on white matter attenuated inversion recovery MR images. Quantitative intraoperative clinical assessments were performed using accelerometry. EF simulations (n = 272) for intraoperative stimulation test data performed along two trajectories per side were set-up using the finite element method for 143 stimulation test positions. The resulting EF isosurface of 0.2 V/mm was superimposed to the outlined anatomical structures. The percentage of volume of each structure’s overlap was calculated and related to the corresponding clinical improvement. The proposed concept has been successfully applied to the five patients. For higher clinical improvements, not only the VIM but as well other neighboring structures were covered by the EF isosurfaces. The percentage of the volumes of the VIM, of the nucleus intermediate lateral of the thalamus and the prelemniscal radiations within the prerubral field of Forel increased for clinical improvements higher than 50% compared to improvements lower than 50%. The presented new concept allows a detailed and objective analysis of a high amount of intraoperative data to identify the optimal stimulation target. First results indicate agreement with published data hypothesizing that the stimulation of other structures than the VIM might be responsible for good clinical effects in essential tremor. (Clinical trial reference number: Ref: 2011-A00774-37/AU905)

  • 13.
    Johansson, Johannes
    et al.
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Modelling Details for Electric Field Simulations of Deep Brain Stimulation2019In: WORLD CONGRESS ON MEDICAL PHYSICS AND BIOMEDICAL ENGINEERING 2018, VOL 1, SPRINGER , 2019, Vol. 68, no 1, p. 645-648Conference paper (Refereed)
    Abstract [en]

    Deep brain stimulation is a well-established technique for symptomatic treatment of e.g. Parkinsons disease and essential tremor. Computer simulations using the finite element method (FEM) are widely used to estimate the affected area around the DBS electrodes. For the reliability of the simulations, it is important to match used simulation parameters with experimental data. One such parameter is the electric field magnitude threshold EFt required for axon stimulation. Another is the conductivity of the perielectrode space (PES) around the electrode. At the acute stage after surgery the PES will be characterized by an increased conductivity due to inflammation and edema while the later chronic stage will be characterized by a lower conductivity due to gliosis and minor scar formation. In this study, the EFt and the electric conductivity of the PES have been estimated by comparing FEM simulations with clinical studies of activation distance, pulse length and electrode impedance. The resulting estimates are an EFt of 0.2 V/mm at the common pulse width of 60 mu s and a chronaxie of 62 mu s. Estimated electric conductivities for the PES are 0.14 S/m in the acute stage and 0.05 S/m in the chronic stage, assuming a PES width of 250 mu m. These values are thus experimentally justified to use in FEM simulations of DBS.

  • 14.
    Johansson, johannes
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Patient-Specific Finite Element Simulations of Deep Brain Stimulation – Electrode Placement Using Leksell Coordinates2016Conference paper (Other academic)
    Abstract [en]

    Deep brain stimulation (DBS) is used for symptomatic treatment of movement disorders. Finite element method (FEM) simulations are useful for estimating the affected region around the electrode which can help determine the optimal target. This paper presents how the patient-specific electrode placement is simplified by the use of two Leksell coordinates in the postoperative imaging artefacts. The method is implemented in Comsol Multiphysics and exemplified by a patient-specific simulation in zona incerta (Zi).

  • 15.
    Johansson, Johannes
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Wårdell, Karin
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, Faculty of Science & Engineering.
    Simulering av aktiverade strukturer vid djup hjärnstimulering (DBS)2016Conference paper (Other academic)
    Abstract [sv]

    Djup hjärnstimulering är en metod för att lindra symptom från patologisk överaktivitet i hjärnanscentrala delar vid exempelvis Parkinsons sjukdom, dystoni och essentiell tremor. En litenelektrod implanteras kroniskt i det överaktiva området vilket störs ut med pulser från elektroden.I denna presentation beskrivs hur patientspecifika simuleringar med finita elementmetoden(FEM) kan utföras för att uppskatta vilka strukturer som aktiveras vid olikaelektrodinställningar. Patientens bilder från magnetresonanstomografi (MR) och datortomografikoregistreras och används för att bedöma elektrodens position och den elektriskaledningsförmågan i hjärnvävnaden kring den genom att klassificera vävnaden i grå och vithjärnvävnad samt cerebrospinalvätska och blod. Modeller för statisk strömledning baserade pådenna information och elektrodens inställningar skapas därefter i FEM-mjukvaran ComsolMultiphysics och simuleringar utförs. Aktiveringsområden baserade på den elektriskafältstyrkan och typiska diametrar på neuronernas axoner kan därefter överlagras med MR-bilderna för att bedöma vilka strukturer som påverkas. Detta möjliggör jämförelse med kliniskeffekt och eventuella biverkningar av stimuleringen hos patienterna. För närvarande undersökervi exempelvis DBS mot Tourettes syndrom och gör jämförelser mellan elektrodposition ochaccelerometermätningar vid DBS mot skakningar.

  • 16.
    Shah, Ashesh
    et al.
    Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Lemarie, Jean-Jacques
    Clermont Université, Université d'Auvergne, EA 3295, Equipe de recherche en signal et imagerie médicale, Image- Guided Clinical Neuroscience and Connectomics (IGCNC), BP 10448, F-63000 Clermont-Ferrand, France/CHU Clermont-Ferrand, Service de Neurochirurgie, F-63003 Clermont-Ferrand, France..
    Pison, Daniela
    Institute for Medical and Analytical Technologies, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Muttenz, Switzerland..
    Coste, Jérôme
    Université Clermont Auvergne, Université d’Auvergne, EA 7282, Image Guided Clinical Neurosciences and Connectomics (IGCNC), Clermont-Ferrand, France; Service de Neurochirurgie, Hôpital Gabriel-Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France..
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Schkommodau, Erik
    Institute for Medical and Analytical Technologies, University of Applied Sciences and Art Northwestern Switzerland.
    Hemm-Ode, Simone
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Institute for Medical and Analytical Technologies and Department of Biomedical Engineering, University of Applied Sciences and Art Northwestern Switzerland.
    Learning more about the optimal anatomical position for deep brain stimulation in essential tremor patients: 3D visualisation of intraoperative stimulation test results2017Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION

    The outcome of deep brain stimulation (DBS) depends heavily on the position of the implanted lead. After a preoperative anatomical planning, most groups collect numerous intraoperative data such as therapeutic effects induced by stimulation tests. To choose the final implant position, physicians “mentally” visualise all available data. The aim of the present work was to develop a method visualising intraoperative stimulation test results, patient’s images, electric field (EF) simulations for the patient-specific stimulation conditions and the corresponding therapeutic effects quantitatively evaluated by accelerometry. The application to five essential tremor (ET) patients should give a first idea about the optimal target position. 

    METHODS

    In Clermont-Ferrand University Hospital the anatomic target structure and the neighbouring structures were manually outlined, a target and a trajectory defined and two parallel trajectories per hemisphere intraoperatively evaluated. Stimulation tests were performed at 7 to 8 positions per trajectory and several stimulation current amplitudes. The therapeutic effect was evaluated using a previously published method based on accelerometry. Finite element models and simulations were performed for up to three stimulation amplitudes per position and EF isosurfaces (0.2V/mm) were extracted. For the 3D visualization of the numerous overlapping isosurfaces, we generated “improvement maps” by assigning to each voxel within the isosurfaces the highest tremor improvement. Those maps were visualized together with anatomical images, delineated structures and trajectories (Paraview, Kitware Inc). The method was applied to 5 ET patients implanted in the ventro-intermediate nucleus of the thalamus (VIM). Results were analysed by the neurosurgeon regarding the optimal implant position.  

    RESULTS

    The clinical teams were able to identify the optimal implant position for all patients with more ease and in less time compared to the routine discussion using pen and paper. Additionally, for 7 of the 9 improvement maps, the highest improvement region was found to be in the posterior subthalamic area, inferior and posterior to the VIM.

    CONCLUSION

    Improvement maps assist the clinicians in determining the optimal implant location of the chronic DBS lead. Results support findings of other studies that the fibre tracts in the posterior subthalamic area like prelemniscal radiations may be responsible for alleviating tremor in ET patients.

  • 17.
    Wårdell, Karin
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Alonso, Fabiola
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Computational Finite Element Model to Compare Voltage and Current Controlled Deep Brain Stimulation Systems2013Conference paper (Refereed)
  • 18.
    Wårdell, Karin
    et al.
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Johansson, Johannes
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Alonso, Fabiola
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Deep brain stimulation: software for patient-specific electric field simulations2017Conference paper (Refereed)
    Abstract [en]

    Introduction

    The electric field (EF) around the active deep brain stimulation (DBS) contact is of interest for optimizing the therapeutic effect. We have previously developed a method for simulation and visualization of the EF. The aim of the project is to improve the software for quick and user friendly simulations.  

    Methods

    The ELMA software for brain model creation has been improved by adding quick ROI selection and transformation to an electrical conductivity map based on tissue classification through multiple slices of the preoperative MRI. These data are used as input for Comsol Multiphysics simulations of the EF. Two points along the position of the lead, as seen in the postoperative images, are used for correct placement in the brain model. Multiple DBS lead models are pre-programmed. The active contact and amplitude are user-selected.

    Results

    After a simulation the result is visualized with a user defined isolevel or isosurface superimposed on the patients preoperative MRI. An example is shown in Fig. 1. The 3389 lead is places in zona inserta (Zi) and contact 1 activated with 2 and 4 V respectively. An isolevel of 0.2 V/mm is used corresponding to a ~ 3-4 µm axon diameter when using a pulse length of 60 µs. More examples will be presented at the meeting.

    Conclusion

    The software for patient-specific simulations of EF around DBS electrodes has been improved for quicker simulations and more DBS leads. As a next step user friendly Apps will be implemented.

1 - 18 of 18
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf