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Karl JA, Joyce JM, Ouyang B, Gill CE, Verhagen Metman L. Directional Deep Brain Stimulation Programming: Is the Segment Clearly Identifiable and Stable Over Time? Mov Disord Clin Pract 2024; 11:992-997. [PMID: 38853400 PMCID: PMC11329556 DOI: 10.1002/mdc3.14120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 05/12/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND In our early experience programming directional deep brain stimulation (d-DBS) in PD, we found the optimal directional segment changed over time in some patients. To determine the frequency/reasons for this we examined whether (1) different programmers would identify the same segment as "optimal"; and (2) the same programmer would select the same "optimal" segment over time. We hypothesized there would be a moderately high level of agreement on optimal electrode selection between different assessors and repeated assessments by the same evaluator. METHODS This was a prospective, double-blind investigation evaluating the reliability and stability of programming d-DBS. Each patient underwent a mono-polar survey four times (2 time points by 2 separate assessors). The primary aim was the inter-rater agreement of selecting the optimal electrode at 1 and 6 months. The secondary aim was to determine the intra-rater agreement of selecting the optimal electrode from 1 to 6 months. RESULTS Twenty-one patients were enrolled. There was fair inter-rater agreement at 1 month and moderate at 6 months. There was minimal intra-rater agreement between 1 and 6 months. DISCUSSION The data refuted our hypothesis. Potential reasons for low agreement include (1) the arduous/subjective nature of identifying the optimal electrode in d-DBS systems, especially in well-placed electrodes; and/or (2) acute changes to the location of stimulation delivery offering temporary improvement in symptoms. Key takeaways gathered were it may, (1) behoove the programmer to explore different electrode montages after a period of time; and (2) be more efficient to review the directional electrode montage only when dictated by clinical symptoms/disease progression.
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Affiliation(s)
- Jessica A. Karl
- Movement Disorder Division, Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jessica M. Joyce
- Department of NeurologyRush University Medical CenterChicagoIllinoisUSA
| | - Bichun Ouyang
- Department of NeurologyRush University Medical CenterChicagoIllinoisUSA
| | - Chandler E. Gill
- Department of NeurologyRush University Medical CenterChicagoIllinoisUSA
| | - Leo Verhagen Metman
- Movement Disorder Division, Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Willett A, Wylie SA, Bowersock JL, Dawant BM, Rodriguez W, Ugiliweneza B, Neimat JS, van Wouwe NC. Focused stimulation of dorsal versus ventral subthalamic nucleus enhances action-outcome learning in patients with Parkinson's disease. Brain Commun 2024; 6:fcae111. [PMID: 38646144 PMCID: PMC11032193 DOI: 10.1093/braincomms/fcae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective treatment for the clinical motor symptoms of Parkinson's disease, but may alter the ability to learn contingencies between stimuli, actions and outcomes. We investigated how stimulation of the functional subregions in the subthalamic nucleus (motor and cognitive regions) modulates stimulus-action-outcome learning in Parkinson's disease patients. Twelve Parkinson's disease patients with deep brain stimulation of the subthalamic nucleus completed a probabilistic stimulus-action-outcome task while undergoing ventral and dorsal subthalamic nucleus stimulation (within subjects, order counterbalanced). The task orthogonalized action choice and outcome valence, which created four action-outcome learning conditions: action-reward, inhibit-reward, action-punishment avoidance and inhibit-punishment avoidance. We compared the effects of deep brain stimulation on learning rates across these conditions as well as on computed Pavlovian learning biases. Dorsal stimulation was associated with higher overall learning proficiency relative to ventral subthalamic nucleus stimulation. Compared to ventral stimulation, stimulating the dorsal subthalamic nucleus led to a particular advantage in learning to inhibit action to produce desired outcomes (gain reward or avoid punishment) as well as better learning proficiency across all conditions providing reward opportunities. The Pavlovian reward bias was reduced with dorsal relative to ventral subthalamic nucleus stimulation, which was reflected by improved inhibit-reward learning. Our results show that focused stimulation in the dorsal compared to the ventral subthalamic nucleus is relatively more favourable for learning action-outcome contingencies and reduces the Pavlovian bias that could lead to reward-driven behaviour. Considering the effects of deep brain stimulation of the subthalamic nucleus on learning and behaviour could be important when optimizing stimulation parameters to avoid side effects like impulsive reward-driven behaviour.
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Affiliation(s)
- Andrew Willett
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Scott A Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Jessica L Bowersock
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Benoit M Dawant
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - William Rodriguez
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Nelleke C van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
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Ng PR, Bush A, Vissani M, McIntyre CC, Richardson RM. Biophysical Principles and Computational Modeling of Deep Brain Stimulation. Neuromodulation 2024; 27:422-439. [PMID: 37204360 DOI: 10.1016/j.neurom.2023.04.471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) has revolutionized the treatment of neurological disorders, yet the mechanisms of DBS are still under investigation. Computational models are important in silico tools for elucidating these underlying principles and potentially for personalizing DBS therapy to individual patients. The basic principles underlying neurostimulation computational models, however, are not well known in the clinical neuromodulation community. OBJECTIVE In this study, we present a tutorial on the derivation of computational models of DBS and outline the biophysical contributions of electrodes, stimulation parameters, and tissue substrates to the effects of DBS. RESULTS Given that many aspects of DBS are difficult to characterize experimentally, computational models have played an important role in understanding how material, size, shape, and contact segmentation influence device biocompatibility, energy efficiency, the spatial spread of the electric field, and the specificity of neural activation. Neural activation is dictated by stimulation parameters including frequency, current vs voltage control, amplitude, pulse width, polarity configurations, and waveform. These parameters also affect the potential for tissue damage, energy efficiency, the spatial spread of the electric field, and the specificity of neural activation. Activation of the neural substrate also is influenced by the encapsulation layer surrounding the electrode, the conductivity of the surrounding tissue, and the size and orientation of white matter fibers. These properties modulate the effects of the electric field and determine the ultimate therapeutic response. CONCLUSION This article describes biophysical principles that are useful for understanding the mechanisms of neurostimulation.
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Affiliation(s)
| | - Alan Bush
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Matteo Vissani
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Robert Mark Richardson
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
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Viana D, Walston ST, Masvidal-Codina E, Illa X, Rodríguez-Meana B, Del Valle J, Hayward A, Dodd A, Loret T, Prats-Alfonso E, de la Oliva N, Palma M, Del Corro E, Del Pilar Bernicola M, Rodríguez-Lucas E, Gener T, de la Cruz JM, Torres-Miranda M, Duvan FT, Ria N, Sperling J, Martí-Sánchez S, Spadaro MC, Hébert C, Savage S, Arbiol J, Guimerà-Brunet A, Puig MV, Yvert B, Navarro X, Kostarelos K, Garrido JA. Nanoporous graphene-based thin-film microelectrodes for in vivo high-resolution neural recording and stimulation. NATURE NANOTECHNOLOGY 2024; 19:514-523. [PMID: 38212522 PMCID: PMC11026161 DOI: 10.1038/s41565-023-01570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/07/2023] [Indexed: 01/13/2024]
Abstract
One of the critical factors determining the performance of neural interfaces is the electrode material used to establish electrical communication with the neural tissue, which needs to meet strict electrical, electrochemical, mechanical, biological and microfabrication compatibility requirements. This work presents a nanoporous graphene-based thin-film technology and its engineering to form flexible neural interfaces. The developed technology allows the fabrication of small microelectrodes (25 µm diameter) while achieving low impedance (∼25 kΩ) and high charge injection (3-5 mC cm-2). In vivo brain recording performance assessed in rodents reveals high-fidelity recordings (signal-to-noise ratio >10 dB for local field potentials), while stimulation performance assessed with an intrafascicular implant demonstrates low current thresholds (<100 µA) and high selectivity (>0.8) for activating subsets of axons within the rat sciatic nerve innervating tibialis anterior and plantar interosseous muscles. Furthermore, the tissue biocompatibility of the devices was validated by chronic epicortical (12 week) and intraneural (8 week) implantation. This work describes a graphene-based thin-film microelectrode technology and demonstrates its potential for high-precision and high-resolution neural interfacing.
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Affiliation(s)
- Damià Viana
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Steven T Walston
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Eduard Masvidal-Codina
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Xavi Illa
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Campus UAB, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - Bruno Rodríguez-Meana
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Del Valle
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Universitat Autònoma de Barcelona, Barcelona, Spain
- Secció de Fisiologia, Department de Bioquímica i Fisiologia, Facultat de Farmàcia i Ciències de l'Alimentació, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Andrew Hayward
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology, Medicine & Health, Manchester, UK
| | - Abbie Dodd
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology, Medicine & Health, Manchester, UK
| | - Thomas Loret
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology, Medicine & Health, Manchester, UK
| | - Elisabet Prats-Alfonso
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Campus UAB, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - Natàlia de la Oliva
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marie Palma
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Elena Del Corro
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - María Del Pilar Bernicola
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Elisa Rodríguez-Lucas
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
| | - Thomas Gener
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
| | - Jose Manuel de la Cruz
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Miguel Torres-Miranda
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Fikret Taygun Duvan
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Nicola Ria
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Justin Sperling
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Sara Martí-Sánchez
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Maria Chiara Spadaro
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Clément Hébert
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
| | - Sinead Savage
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology, Medicine & Health, Manchester, UK
| | - Jordi Arbiol
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - Anton Guimerà-Brunet
- Institut de Microelectrònica de Barcelona, IMB-CNM (CSIC), Campus UAB, Bellaterra, Spain
| | - M Victoria Puig
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
| | - Blaise Yvert
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Xavier Navarro
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Kostas Kostarelos
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain.
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Universitat Autònoma de Barcelona, Barcelona, Spain.
- Nanomedicine Lab, National Graphene Institute and Faculty of Biology, Medicine & Health, Manchester, UK.
| | - Jose A Garrido
- Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Barcelona, Spain.
- ICREA, Barcelona, Spain.
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Warren AEL, Tobochnik S, Chua MMJ, Singh H, Stamm MA, Rolston JD. Neurostimulation for Generalized Epilepsy: Should Therapy be Syndrome-specific? Neurosurg Clin N Am 2024; 35:27-48. [PMID: 38000840 PMCID: PMC10676463 DOI: 10.1016/j.nec.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Current applications of neurostimulation for generalized epilepsy use a one-target-fits-all approach that is agnostic to the specific epilepsy syndrome and seizure type being treated. The authors describe similarities and differences between the 2 "archetypes" of generalized epilepsy-Lennox-Gastaut syndrome and Idiopathic Generalized Epilepsy-and review recent neuroimaging evidence for syndrome-specific brain networks underlying seizures. Implications for stimulation targeting and programming are discussed using 5 clinical questions: What epilepsy syndrome does the patient have? What brain networks are involved? What is the optimal stimulation target? What is the optimal stimulation paradigm? What is the plan for adjusting stimulation over time?
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Affiliation(s)
- Aaron E L Warren
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Steven Tobochnik
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa M J Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hargunbir Singh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela A Stamm
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Asir B, Boscutti A, Fenoy AJ, Quevedo J. Deep Brain Stimulation (DBS) in Treatment-Resistant Depression (TRD): Hope and Concern. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:161-186. [PMID: 39261429 DOI: 10.1007/978-981-97-4402-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
In this chapter, we explore the historical evolution, current applications, and future directions of Deep Brain Stimulation (DBS) for Treatment-Resistant Depression (TRD). We begin by highlighting the early efforts of neurologists and neurosurgeons who laid the foundations for today's DBS techniques, moving from controversial lobotomies to the precision of stereotactic surgery. We focus on the advent of DBS, emphasizing its emergence as a significant breakthrough for movement disorders and its extension to psychiatric conditions, including TRD. We provide an overview of the neural networks implicated in depression, detailing the rationale for the choice of common DBS targets. We also cover the technical aspects of DBS, from electrode placement to programming and parameter selection. We then critically review the evidence from clinical trials and open-label studies, acknowledging the mixed outcomes and the challenges posed by placebo effects and trial design. Safety and ethical considerations are also discussed. Finally, we explore innovative directions for DBS research, including the potential of closed-loop systems, dual stimulation strategies, and noninvasive alternatives like ultrasound neuromodulation. In the last section, we outline recommendations for future DBS studies, including the use of alternative designs for placebo control, the collection of neural and behavioral recordings, and the application of machine-learning approaches.
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Affiliation(s)
- Bashar Asir
- Department of Psychiatry and Behavioral Sciences at McGovern Medical School, UTHealth Houston, Houston, TX, USA.
| | - Andrea Boscutti
- Department of Psychiatry and Behavioral Sciences at McGovern Medical School, UTHealth Houston, Houston, TX, USA
| | - Albert J Fenoy
- Department of Neurosurgery and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joao Quevedo
- Department of Psychiatry and Behavioral Sciences at McGovern Medical School, UTHealth Houston, Houston, TX, USA
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Mirzakhalili E, Rogers ER, Lempka SF. An optimization framework for targeted spinal cord stimulation. J Neural Eng 2023; 20:056026. [PMID: 37647885 PMCID: PMC10535048 DOI: 10.1088/1741-2552/acf522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/01/2023]
Abstract
Objective. Spinal cord stimulation (SCS) is a common neurostimulation therapy to manage chronic pain. Technological advances have produced new neurostimulation systems with expanded capabilities in an attempt to improve the clinical outcomes associated with SCS. However, these expanded capabilities have dramatically increased the number of possible stimulation parameters and made it intractable to efficiently explore this large parameter space within the context of standard clinical programming procedures. Therefore, in this study, we developed an optimization approach to define the optimal current amplitudes or fractions across individual contacts in an SCS electrode array(s).Approach. We developed an analytic method using the Lagrange multiplier method along with smoothing approximations. To test our optimization framework, we used a hybrid computational modeling approach that consisted of a finite element method model and multi-compartment models of axons and cells within the spinal cord. Moreover, we extended our approach to multi-objective optimization to explore the trade-off between activating regions of interest (ROIs) and regions of avoidance (ROAs).Main results. For simple ROIs, our framework suggested optimized configurations that resembled simple bipolar configurations. However, when we considered multi-objective optimization, our framework suggested nontrivial stimulation configurations that could be selected from Pareto fronts to target multiple ROIs or avoid ROAs.Significance. We developed an optimization framework for targeted SCS. Our method is analytic, which allows for the fast calculation of optimal solutions. For the first time, we provided a multi-objective approach for selective SCS. Through this approach, we were able to show that novel configurations can provide neural recruitment profiles that are not possible with conventional stimulation configurations (e.g. bipolar stimulation). Most importantly, once integrated with computational models that account for sources of interpatient variability (e.g. anatomy, electrode placement), our optimization framework can be utilized to provide stimulation settings tailored to the needs of individual patients.
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Affiliation(s)
- Ehsan Mirzakhalili
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Evan R Rogers
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States of America
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States of America
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Henry KR, Miulli MM, Nuzov NB, Nolt MJ, Rosenow JM, Elahi B, Pilitsis J, Golestanirad L. Variations in Determining Actual Orientations of Segmented Deep Brain Stimulation Leads Using the DiODe Algorithm: A Retrospective Study Across Different Lead Designs and Medical Institutions. Stereotact Funct Neurosurg 2023; 101:338-347. [PMID: 37717576 PMCID: PMC10866684 DOI: 10.1159/000531644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/12/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Directional deep brain stimulation (DBS) leads have become widely used in the past decade. Understanding the asymmetric stimulation provided by directional leads requires precise knowledge of the exact orientation of the lead in respect to its anatomical target. Recently, the DiODe algorithm was developed to automatically determine the orientation angle of leads from the artifact on postoperative computed tomography (CT) images. However, manual DiODe results are user-dependent. This study analyzed the extent of lead rotation as well as the user agreement of DiODe calculations across the two most common DBS systems, namely, Boston Scientific's Vercise and Abbott's Infinity, and two independent medical institutions. METHODS Data from 104 patients who underwent an anterior-facing unilateral/bilateral directional DBS implantation at either Northwestern Memorial Hospital (NMH) or Albany Medical Center (AMC) were retrospectively analyzed. Actual orientations of the implanted leads were independently calculated by three individual users using the DiODe algorithm in Lead-DBS and patients' postoperative CT images. The deviation from the intended orientation and user agreement were assessed. RESULTS All leads significantly deviated from the intended 0° orientation (p < 0.001), regardless of DBS lead design (p < 0.05) or institution (p < 0.05). However, the Boston Scientific leads showed an implantation bias toward the left at both institutions (p = 0.014 at NMH, p = 0.029 at AMC). A difference of 10° between at least two users occurred in 28% (NMH) and 39% (AMC) of all Boston Scientific and 76% (NMH) and 53% (AMC) of all Abbott leads. CONCLUSION Our results show that there is a significant lead rotation from the intended surgical orientation across both DBS systems and both medical institutions; however, a bias toward a single direction was only seen in the Boston Scientific leads. Additionally, these results raise questions into the user error that occurs when manually refining the orientation angles calculated with DiODe.
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Affiliation(s)
- Kaylee R Henry
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA,
| | - Milina Michelle Miulli
- Department of Neuroscience and Department of Global Health Studies, Northwestern University, Evanston, Illinois, USA
| | - Noa B Nuzov
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Mark J Nolt
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Behzad Elahi
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
- Department of Neurology, Loyola Medical Center, Maywood, Illinois, USA
| | - Julie Pilitsis
- Department of Neurosciences and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Laleh Golestanirad
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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Radcliffe EM, Baumgartner AJ, Kern DS, Al Borno M, Ojemann S, Kramer DR, Thompson JA. Oscillatory beta dynamics inform biomarker-driven treatment optimization for Parkinson's disease. J Neurophysiol 2023; 129:1492-1504. [PMID: 37198135 DOI: 10.1152/jn.00055.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 05/19/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons and dysregulation of the basal ganglia. Cardinal motor symptoms include bradykinesia, rigidity, and tremor. Deep brain stimulation (DBS) of select subcortical nuclei is standard of care for medication-refractory PD. Conventional open-loop DBS delivers continuous stimulation with fixed parameters that do not account for a patient's dynamic activity state or medication cycle. In comparison, closed-loop DBS, or adaptive DBS (aDBS), adjusts stimulation based on biomarker feedback that correlates with clinical state. Recent work has identified several neurophysiological biomarkers in local field potential recordings from PD patients, the most promising of which are 1) elevated beta (∼13-30 Hz) power in the subthalamic nucleus (STN), 2) increased beta synchrony throughout basal ganglia-thalamocortical circuits, notably observed as coupling between the STN beta phase and cortical broadband gamma (∼50-200 Hz) amplitude, and 3) prolonged beta bursts in the STN and cortex. In this review, we highlight relevant frequency and time domain features of STN beta measured in PD patients and summarize how spectral beta power, oscillatory beta synchrony, phase-amplitude coupling, and temporal beta bursting inform PD pathology, neurosurgical targeting, and DBS therapy. We then review how STN beta dynamics inform predictive, biomarker-driven aDBS approaches for optimizing PD treatment. We therefore provide clinically useful and actionable insight that can be applied toward aDBS implementation for PD.
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Affiliation(s)
- Erin M Radcliffe
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Alexander J Baumgartner
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Mazen Al Borno
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Computer Science and Engineering, University of Colorado Denver, Denver, Colorado, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Daniel R Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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10
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Holland MT, Jiao J, Mantovani A, Anderson S, Mitchell KA, Safarpour D, Burchiel KJ. Identifying the therapeutic zone in globus pallidus deep brain stimulation for Parkinson's disease. J Neurosurg 2023; 138:329-336. [PMID: 35901683 DOI: 10.3171/2022.5.jns22152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The globus pallidus internus (GPI) has been demonstrated to be an effective surgical target for deep brain stimulation (DBS) treatment in patients with medication-refractory Parkinson's disease (PD). The ability of neurosurgeons to define the area of greatest therapeutic benefit within the globus pallidus (GP) may improve clinical outcomes in these patients. The objective of this study was to determine the best DBS therapeutic implantation site within the GP for effective treatment in PD patients. METHODS The authors performed a retrospective review of 56 patients who underwent bilateral GP DBS implantation at their institution during the period from January 2015 to January 2020. Each implanted contact was anatomically localized. Patients were followed for stimulation programming for at least 6 months. The authors reviewed preoperative and 6-month postsurgery clinical outcomes based on data from the Unified Parkinson's Disease Rating Scale Part III (UPDRS III), dyskinesia scores, and levodopa equivalent daily dose (LEDD). RESULTS Of the 112 leads implanted, the therapeutic cathode was most frequently located in the lamina between the GPI external segment (GPIe) and the GP externus (GPE) (n = 40). Other common locations included the GPE (n = 24), the GPIe (n = 15), and the lamina between the GPI internal segment (GPIi) and the GPIe (n = 14). In the majority of patients (73%) a monopolar programming configuration was used. At 6 months postsurgery, UPDRS III off medications (OFF) and on stimulation (ON) scores significantly improved (z = -4.02, p < 0.001), as did postsurgery dyskinesia ON scores (z = -4.08, p < 0.001) and postsurgery LEDD (z = -4.7, p < 0.001). CONCLUSIONS Though the ventral GP (pallidotomy target) has been a commonly used target for GP DBS, a more dorsolateral target may be more effective for neuromodulation strategies. The assessment of therapeutic contact locations performed in this study showed that the lamina between GPI and GPE used in most patients is the optimal central stimulation target. This information should improve preoperative GP targeting.
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Affiliation(s)
- Marshall T Holland
- 1Department of Neurological Surgery, University of Alabama at Birmingham, Alabama; and
| | | | - Alessandra Mantovani
- 3Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Katherine A Mitchell
- 3Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Kim J Burchiel
- 3Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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11
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Kang W, Ju C, Joo J, Lee J, Shon YM, Park SM. Closed-loop direct control of seizure focus in a rodent model of temporal lobe epilepsy via localized electric fields applied sequentially. Nat Commun 2022; 13:7805. [PMID: 36528681 PMCID: PMC9759546 DOI: 10.1038/s41467-022-35540-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Direct electrical stimulation of the seizure focus can achieve the early termination of epileptic oscillations. However, direct intervention of the hippocampus, the most prevalent seizure focus in temporal lobe epilepsy is thought to be not practicable due to its large size and elongated shape. Here, in a rat model, we report a sequential narrow-field stimulation method for terminating seizures, while focusing stimulus energy at the spatially extensive hippocampal structure. The effects and regional specificity of this method were demonstrated via electrophysiological and biological responses. Our proposed modality demonstrates spatiotemporal preciseness and selectiveness for modulating the pathological target region which may have potential for further investigation as a therapeutic approach.
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Affiliation(s)
- Wonok Kang
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Chanyang Ju
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Jaesoon Joo
- Biomedical Engineering Research Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351, South Korea
| | - Jiho Lee
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Young-Min Shon
- Biomedical Engineering Research Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351, South Korea.
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351, Republic of Korea.
| | - Sung-Min Park
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Medical Device Innovation Center, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
- Institute of Convergence Science, Yonsei University, Seoul, 03722, Republic of Korea.
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12
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Bove F, Genovese D, Moro E. Developments in the mechanistic understanding and clinical application of deep brain stimulation for Parkinson's disease. Expert Rev Neurother 2022; 22:789-803. [PMID: 36228575 DOI: 10.1080/14737175.2022.2136030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION. Deep brain stimulation (DBS) is a life-changing treatment for patients with Parkinson's disease (PD) and gives the unique opportunity to directly explore how basal ganglia work. Despite the rapid technological innovation of the last years, the untapped potential of DBS is still high. AREAS COVERED. This review summarizes the developments in the mechanistic understanding of DBS and the potential clinical applications of cutting-edge technological advances. Rather than a univocal local mechanism, DBS exerts its therapeutic effects through several multimodal mechanisms and involving both local and network-wide structures, although crucial questions remain unexplained. Nonetheless, new insights in mechanistic understanding of DBS in PD have provided solid bases for advances in preoperative selection phase, prediction of motor and non-motor outcomes, leads placement and postoperative stimulation programming. EXPERT OPINION. DBS has not only strong evidence of clinical effectiveness in PD treatment, but technological advancements are revamping its role of neuromodulation of brain circuits and key to better understanding PD pathophysiology. In the next few years, the worldwide use of new technologies in clinical practice will provide large data to elucidate their role and to expand their applications for PD patients, providing useful insights to personalize DBS treatment and follow-up.
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Affiliation(s)
- Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Genovese
- Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM, U1216, Grenoble, France
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13
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Li L, Jiang C, Duan W, Wang Z, Zhang F, He C, Long T, Li L. Electrochemical and biological performance of hierarchical platinum-iridium electrodes structured by a femtosecond laser. MICROSYSTEMS & NANOENGINEERING 2022; 8:96. [PMID: 36065436 PMCID: PMC9440118 DOI: 10.1038/s41378-022-00433-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/20/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
Neural electrode interfaces are essential to the stimulation safety and recording quality of various bioelectronic therapies. The recently proposed hierarchical platinum-iridium (Pt-Ir) electrodes produced by femtosecond lasers have exhibited superior electrochemical performance in vitro, but their in vivo performance is still unclear. In this study, we explored the electrochemical performance, biological response, and tissue adhesion of hierarchical Pt-Ir electrodes by implantation in adult rat brains for 1, 8, and 16 weeks. Regular smooth Pt-Ir electrodes were used as a control. The results showed that the electrochemical performance of both electrodes decreased and leveled off during implantation. However, after 16 weeks, the charge storage capacity of hierarchical electrodes stabilized at ~16.8 mC/cm2, which was 15 times that of the smooth control electrodes (1.1 mC/cm2). Moreover, the highly structured electrodes had lower impedance amplitude and cutoff frequency values. The similar histological response to smooth electrodes indicated good biocompatibility of the hierarchically structured Pt-Ir electrodes. Given their superior in vivo performance, the femtosecond laser-treated Pt-Ir electrode showed great potential for neuromodulation applications.
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Affiliation(s)
- Linze Li
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084 China
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, 350108 China
| | - Changqing Jiang
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084 China
| | - Wanru Duan
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Zhiyan Wang
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084 China
| | - Feng Zhang
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084 China
| | - Changgeng He
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084 China
| | - Tiangang Long
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084 China
| | - Luming Li
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084 China
- Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, 518071 China
- IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, 100084 China
- Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, 100093 China
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14
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Impacts of stimulus parameters and configurations on motor cortex direct electrical stimulation using intrinsic optical imaging: a pilot study. Biomed Eng Online 2022; 21:58. [PMID: 36038875 PMCID: PMC9422127 DOI: 10.1186/s12938-022-01026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background Motor cortex stimulation applied as a clinical treatment for neuropathic disorders for decades. With stimulation electrodes placed directly on the cortical surface, this neuromodulation method provides higher spatial resolution than other non-invasive therapies. Yet, the therapeutic effects reported were not in conformity with different syndromes. One of the main issues is that the stimulation parameters are always determined by clinical experience. The lack of understanding about how the stimulation current propagates in the cortex and various stimulation parameters and configurations obstruct the development of this method. Methods In this study, we investigated the effect of different stimulation configurations on cortical responses to motor cortical stimulations using intrinsic optical imaging. Results Our results showed that the cortical activation of electrical stimulation is not only related to the current density but also related to the propagation distance. Besides, stimulation configurations also affect the propagation of the stimulation current. Conclusions All these results provide preliminary experimental evidence for parameter and electrode configuration optimizations.
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15
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Rustogi P, Judy JW. Microgaskets for High-Channel-Density Reconnectable Implantable Packaging. JOURNAL OF MICROELECTROMECHANICAL SYSTEMS : A JOINT IEEE AND ASME PUBLICATION ON MICROSTRUCTURES, MICROACTUATORS, MICROSENSORS, AND MICROSYSTEMS 2022; 31:384-392. [PMID: 35663544 PMCID: PMC9162095 DOI: 10.1109/jmems.2022.3159487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Demands for implantable bioelectronic devices to increase the number of channels for greater functional capacity and resolution, shrink implant size to minimize tissue response and patient burden, and support battery changes and electronics upgrades for long-term operational viability, cannot be met with existing implant-connector technology. In this paper we describe our novel approach to develop a rematable high-channel-density implant-connector technology, with a focus on the design, fabrication, and characterization of its microgasket. The microgaskets made of polydimethylsiloxane elastomer (PDMSe) have achieved much better electrical isolation for neural stimulation (~5 MΩ at 10 kHz) compared with conventional implant connectors (50 kΩ at 10 kHz), despite a 200-fold increase in channel density (conventional: ~0.0644 ch/mm2, microgasket: ~12.8 ch/mm2). The microgaskets also achieved high electrical isolation for neural recording (i.e., ~35 MΩ at 1 kHz) at the same high channel density. When mechanically compressed the microscale vias in the PDMSe microgaskets deform laterally, which could damage or enhance gasket-traversing conductive spring elements in each microscale via depending on their design. We have demonstrated that by lowering the height-to-width aspect ratio of the gasket vias, they can maintain their shape under clamping pressures high enough to achieve high isolation.
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Affiliation(s)
- Paritosh Rustogi
- Electrical and Computer Engineering Department and the Nanoscience Institute for Medical and Engineering Technology, University of Florida, Gainesville, FL 32611 USA
| | - Jack W Judy
- Electrical and Computer Engineering Department, Biomedical Engineering Department, Department of Neurology, and the Nanoscience Institute for Medical and Engineering Technology, University of Florida, Gainesville, FL 32611 USA
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16
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Frey J, Cagle J, Johnson KA, Wong JK, Hilliard JD, Butson CR, Okun MS, de Hemptinne C. Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches. Front Neurol 2022; 13:825178. [PMID: 35356461 PMCID: PMC8959612 DOI: 10.3389/fneur.2022.825178] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and "connectomics" will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kara A. Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Justin D. Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher R. Butson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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17
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Bujarski KA, Song Y, Xie T, Leeds Z, Kolankiewicz SI, Wozniak GH, Guillory S, Aronson JP, Chang L, Jobst BC. Modulation of Emotion Perception via Amygdala Stimulation in Humans. Front Neurosci 2022; 15:795318. [PMID: 35221888 PMCID: PMC8864965 DOI: 10.3389/fnins.2021.795318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/28/2021] [Indexed: 12/20/2022] Open
Abstract
Background Multiple lines of evidence show that the human amygdala is part of a neural network important for perception of emotion from environmental stimuli, including for processing of intrinsic attractiveness/“goodness” or averseness/“badness,” i.e., affective valence. Objective/Hypothesis With this in mind, we investigated the effect of electrical brain stimulation of the human amygdala on perception of affective valence of images taken from the International Affective Picture Set (IAPS). Methods Using intracranial electrodes in patients with epilepsy, we first obtained event-related potentials (ERPs) in eight patients as they viewed IAPS images of varying affective valence. Next, in a further cohort of 10 patients (five female and five male), we measured the effect of 50 Hz electrical stimulation of the left amygdala on perception of affective valence from IAPS images. Results We recorded distinct ERPs from the left amygdala and found significant differences in the responses between positively and negatively valenced stimuli (p = 0.002), and between neutral and negatively valenced stimuli (p = 0.017) 300–500 ms after stimulus onset. Next, we found that amygdala stimulation did not significantly affect how patients perceived valence for neutral images (p = 0.58), whereas stimulation induced patients to report both positively (p = 0.05) and negatively (< 0.01) valenced images as more neutral. Conclusion These results render further evidence that the left amygdala participates in a neural network for perception of emotion from environmental stimuli. These findings support the idea that electrical stimulation disrupts this network and leads to partial disruption of perception of emotion. Harnessing this effect may have clinical implications in treatment of certain neuropsychiatric disorders using deep brain stimulation (DBS) and neuromodulation.
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Affiliation(s)
- Krzysztof A. Bujarski
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- *Correspondence: Krzysztof A. Bujarski,
| | - Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Tiankang Xie
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
- Department of Quantitative Biomedical Sciences, Dartmouth College, Lebanon, NH, United States
| | - Zachary Leeds
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sophia I. Kolankiewicz
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Gabriella H. Wozniak
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sean Guillory
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Joshua P. Aronson
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Luke Chang
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Barbara C. Jobst
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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18
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Non-motor effects of subthalamic nucleus stimulation in Parkinson patients. Brain Imaging Behav 2022; 16:161-168. [PMID: 35029801 DOI: 10.1007/s11682-021-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/02/2022]
Abstract
The current white matter connectivity analyses of the subthalamic region have focused on the motor effects of deep brain stimulation. We investigate white matter connectivity associated with the stimulation-induced non-motor acute clinical effects in three domains: mood changes, dizziness, and sweating. We performed whole-brain probabilistic tractography seeded from the domain-specific stimulation volumes. The resultant connectivity maps were statistically compared across patients. The cortical voxels associated with each non-motor domain were compared with stimulation-induced motor improvements in a multivariate model. The resulting voxel maps were thresholded for false discovery (FDR q < 0.05) and clustered using a multimodal atlas. We also performed a group-level parcellation of stimulation volumes to identify the local pathways associated with each non-motor domain. The non-motor effects were rarely observed during stimulation titration: from 1100 acute clinical effects, mood change was observed in 14, dizziness in 23, and sweating in 20. Distinct cortical clusters were associated with each domain; notably, mood change was associated with voxels in the salience network and dizziness with voxels in the visual association cortex. The subthalamic parcellation yielded a mediolateral gradient, with the motor parcel being lateral and the non-motor parcels medial. We also observed an anteroposterior organization in the medial non-motor clusters with mood changes being anterior, followed posteriorly by dizziness, and sweating. We interpret these findings based on the literature and foresee these to be useful in guiding DBS programming.
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Yalaz M, Maling N, Deuschl G, Juárez-Paz LM, Butz M, Schnitzler A, Helmers AK, Höft M. MaDoPO: Magnetic Detection of Positions and Orientations of Segmented Deep-Brain Stimulation Electrodes: A Radiation-Free Method Based on Magnetoencephalography. Brain Sci 2022; 12:brainsci12010086. [PMID: 35053829 PMCID: PMC8774199 DOI: 10.3390/brainsci12010086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Current approaches to detect the positions and orientations of directional deep-brain stimulation (DBS) electrodes rely on radiative imaging data. In this study, we aim to present an improved version of a radiation-free method for magnetic detection of the position and the orientation (MaDoPO) of directional electrodes based on a series of magnetoencephalography (MEG) measurements and a possible future solution for optimized results using emerging on-scalp MEG systems. Methods: A directional DBS system was positioned into a realistic head–torso phantom and placed in the MEG scanner. A total of 24 measurements of 180 s each were performed with different predefined electrode configurations. Finite element modeling and model fitting were used to determine the position and orientation of the electrode in the phantom. Related measurements were fitted simultaneously, constraining solutions to the a priori known geometry of the electrode. Results were compared with the results of the high-quality CT imaging of the phantom. Results: The accuracy in electrode localization and orientation detection depended on the number of combined measurements. The localization error was minimized to 2.02 mm by considering six measurements with different non-directional bipolar electrode configurations. Another six measurements with directional bipolar stimulations minimized the orientation error to 4°. These values are mainly limited due to the spatial resolution of the MEG. Moreover, accuracies were investigated as a function of measurement time, number of sensors, and measurement direction of the sensors in order to define an optimized MEG device for this application. Conclusion: Although MEG introduces inaccuracies in the detection of the position and orientation of the electrode, these can be accepted when evaluating the benefits of a radiation-free method. Inaccuracies can be further reduced by the use of on-scalp MEG sensor arrays, which may find their way into clinics in the foreseeable future.
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Affiliation(s)
- Mevlüt Yalaz
- Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany;
- Correspondence:
| | - Nicholas Maling
- Boston Scientific Corporation, Santa Clarita, CA 91355, USA; (N.M.); (L.M.J.-P.)
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany;
| | - León M. Juárez-Paz
- Boston Scientific Corporation, Santa Clarita, CA 91355, USA; (N.M.); (L.M.J.-P.)
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany; (M.B.); (A.S.)
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany; (M.B.); (A.S.)
| | - Ann-Kristin Helmers
- Department of Neurosurgery, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany;
| | - Michael Höft
- Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany;
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20
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Kunigk NG, Urdaneta ME, Malone IG, Delgado F, Otto KJ. Reducing Behavioral Detection Thresholds per Electrode via Synchronous, Spatially-Dependent Intracortical Microstimulation. Front Neurosci 2022; 16:876142. [PMID: 35784835 PMCID: PMC9247280 DOI: 10.3389/fnins.2022.876142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
Intracortical microstimulation (ICMS) has shown promise in restoring quality of life to patients suffering from paralysis, specifically when used in the primary somatosensory cortex (S1). However, these benefits can be hampered by long-term degradation of electrode performance due to the brain's foreign body response. Advances in microfabrication techniques have allowed for the development of neuroprostheses with subcellular electrodes, which are characterized by greater versatility and a less detrimental immune response during chronic use. These probes are hypothesized to enable more selective, higher-resolution stimulation of cortical tissue with long-term implants. However, microstimulation using physiologically relevant charges with these smaller-scale devices can damage electrode sites and reduce the efficacy of the overall device. Studies have shown promise in bypassing this limitation by spreading the stimulation charge between multiple channels in an implanted electrode array, but to our knowledge the usefulness of this strategy in laminar arrays with electrode sites spanning each layer of the cortex remains unexplored. To investigate the efficacy of simultaneous multi-channel ICMS in electrode arrays with stimulation sites spanning cortical depth, we implanted laminar electrode arrays in the primary somatosensory cortex of rats trained in a behavioral avoidance paradigm. By measuring detection thresholds, we were able to quantify improvements in ICMS performance using a simultaneous multi-channel stimulation paradigm. The charge required per site to elicit detection thresholds was halved when stimulating from two adjacent electrode sites, although the overall charge used by the implant was increased. This reduction in threshold charge was more pronounced when stimulating with more than two channels and lessened with greater distance between stimulating channels. Our findings suggest that these improvements are based on the synchronicity and polarity of each stimulus, leading us to conclude that these improvements in stimulation efficiency per electrode are due to charge summation as opposed to a summation of neural responses to stimulation. Additionally, the per-site charge reductions are seen regardless of the cortical depth of each utilized channel. This evocation of physiological detection thresholds with lower stimulation currents per electrode site has implications for the feasibility of stimulation regimes in future advanced neuroprosthetic devices, which could benefit from reducing the charge output per site.
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Affiliation(s)
- Nicolas G. Kunigk
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Morgan E. Urdaneta
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Ian G. Malone
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
| | - Francisco Delgado
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Kevin J. Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
- Department of Materials Science and Engineering, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
- McKnight Brain Institute, University of Florida, Gainesville, FL, United States
- *Correspondence: Kevin J. Otto,
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21
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Marceglia S, Guidetti M, Harmsen IE, Loh A, Meoni S, Foffani G, Lozano AM, Volkmann J, Moro E, Priori A. Deep brain stimulation: is it time to change gears by closing the loop? J Neural Eng 2021; 18. [PMID: 34678794 DOI: 10.1088/1741-2552/ac3267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022]
Abstract
Objective.Adaptive deep brain stimulation (aDBS) is a form of invasive stimulation that was conceived to overcome the technical limitations of traditional DBS, which delivers continuous stimulation of the target structure without considering patients' symptoms or status in real-time. Instead, aDBS delivers on-demand, contingency-based stimulation. So far, aDBS has been tested in several neurological conditions, and will be soon extensively studied to translate it into clinical practice. However, an exhaustive description of technical aspects is still missing.Approach.in this topical review, we summarize the knowledge about the current (and future) aDBS approach and control algorithms to deliver the stimulation, as reference for a deeper undestending of aDBS model.Main results.We discuss the conceptual and functional model of aDBS, which is based on the sensing module (that assesses the feedback variable), the control module (which interpretes the variable and elaborates the new stimulation parameters), and the stimulation module (that controls the delivery of stimulation), considering both the historical perspective and the state-of-the-art of available biomarkers.Significance.aDBS modulates neuronal circuits based on clinically relevant biofeedback signals in real-time. First developed in the mid-2000s, many groups have worked on improving closed-loop DBS technology. The field is now at a point in conducting large-scale randomized clinical trials to translate aDBS into clinical practice. As we move towards implanting brain-computer interfaces in patients, it will be important to understand the technical aspects of aDBS.
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Affiliation(s)
- Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy
| | - Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Irene E Harmsen
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sara Meoni
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy.,Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM U1216, University Grenoble Alpes, Grenoble, France
| | - Guglielmo Foffani
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Jens Volkmann
- Department of Neurology, University of Wurzburg, Wurzburg, Germany
| | - Elena Moro
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM U1216, University Grenoble Alpes, Grenoble, France
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy.,ASST Santi Paolo e Carlo, 20142 Milan, Italy
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22
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Knorr S, Musacchio T, Paulat R, Matthies C, Endres H, Wenger N, Harms C, Ip CW. Experimental deep brain stimulation in rodent models of movement disorders. Exp Neurol 2021; 348:113926. [PMID: 34793784 DOI: 10.1016/j.expneurol.2021.113926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 12/21/2022]
Abstract
Deep brain stimulation (DBS) is the preferred treatment for therapy-resistant movement disorders such as dystonia and Parkinson's disease (PD), mostly in advanced disease stages. Although DBS is already in clinical use for ~30 years and has improved patients' quality of life dramatically, there is still limited understanding of the underlying mechanisms of action. Rodent models of PD and dystonia are essential tools to elucidate the mode of action of DBS on behavioral and multiscale neurobiological levels. Advances have been made in identifying DBS effects on the central motor network, neuroprotection and neuroinflammation in DBS studies of PD rodent models. The phenotypic dtsz mutant hamster and the transgenic DYT-TOR1A (ΔETorA) rat proved as valuable models of dystonia for preclinical DBS research. In addition, continuous refinements of rodent DBS technologies are ongoing and have contributed to improvement of experimental quality. We here review the currently existing literature on experimental DBS in PD and dystonia models regarding the choice of models, experimental design, neurobiological readouts, as well as methodological implications. Moreover, we provide an overview of the technical stage of existing DBS devices for use in rodent studies.
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Affiliation(s)
- Susanne Knorr
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
| | - Thomas Musacchio
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
| | - Raik Paulat
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
| | - Heinz Endres
- University of Applied Science Würzburg-Schweinfurt, Schweinfurt, Germany.
| | - Nikolaus Wenger
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
| | - Christoph Harms
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, Würzburg, Germany.
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23
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Yalaz M, Deuschl G, Sohail Noor M, Butz M, Schnitzler A, Helmers AK, Höft M. Determining the rotational orientation of directional deep brain stimulation electrodes using magnetoencephalography. J Neural Eng 2021; 18. [PMID: 34598173 DOI: 10.1088/1741-2552/ac2c4d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
Objective.The aim of the present study was to evaluate the effect of different electrode configurations on the accuracy of determining the rotational orientation of the directional deep brain stimulation (DBS) electrode with our previously published magnetoencephalography (MEG)-based method.Approach.A directional DBS electrode, along with its implantable pulse generator, was integrated into a head phantom and placed within the MEG sensor array. Predefined bipolar electrode configurations, based on activation of different directional and omnidirectional contacts of the electrode, were set to generate a defined magnetic field during stimulation. This magnetic field was then measured with MEG. Finite element modeling and model fitting approach were used to calculate electrode orientation.Main results.The accuracy of electrode orientation detection depended on the electrode configuration: the vertical configuration (activation of two directional contacts arranged one above the other) achieved an average accuracy of only about 41 ∘. The diagonal configuration (activation of the electrode tip and a single directional contact at the next higher level of the electrode) achieved an accuracy of 13∘, while the horizontal electrode configuration (activation of two adjacent directional contacts at the same electrode level) achieved the best accuracy of 6∘. The accuracy of orientation detection of the DBS electrode depends on the change in spatial distribution of the magnetic field with the rotation of the electrode along its own axis. In the vertical configuration, rotation of the electrode has a small effect on the magnetic field distribution, while in the diagonal or horizontal configuration, electrode rotation has a significant effect on the magnetic field distribution.Significance.Our work suggests that in order to determine rotational orientation of a DBS electrode using MEG, horizontal configuration should be used as it provides the most accurate results compared to other possible configurations.
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Affiliation(s)
- Mevlüt Yalaz
- Chair of Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany
| | - M Sohail Noor
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical iPsychology, Medical Faculty of HHU, 40225 Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical iPsychology, Medical Faculty of HHU, 40225 Düsseldorf, Germany
| | - Ann-Kristin Helmers
- Department of Neurosurgery, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany
| | - Michael Höft
- Chair of Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany
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24
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Bucksot JE, Chandler CR, Intharuck NM, Rennaker RL, Kilgard MP, Hays SA. Validation of a parameterized, open-source model of nerve stimulation. J Neural Eng 2021; 18. [PMID: 34330105 DOI: 10.1088/1741-2552/ac1983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/30/2021] [Indexed: 11/12/2022]
Abstract
Peripheral nerve stimulation is an effective treatment for various neurological disorders. The method of activation and stimulation parameters used impact the efficacy of the therapy, which emphasizes the need for tools to model this behavior. Computational modeling of nerve stimulation has proven to be a useful tool for estimating stimulation thresholds, optimizing electrode design, and exploring previously untested stimulation methods. Despite their utility, these tools require access to and familiarity with several pieces of specialized software. A simpler, streamlined process would increase accessibility significantly. We developed an open-source, parameterized model with a simple online user interface that allows user to adjust up to 36 different parameters (https://nervestimlab.utdallas.edu). The model accurately predicts fiber activation thresholds for nerve and electrode combinations reported in literature. Additionally, it replicates characteristic differences between stimulation methods, such as lower thresholds with monopolar stimulation as compared to tripolar stimulation. The model predicted that the difference in threshold between monophasic and biphasic waveforms, a well-characterized phenomenon, is not present during stimulation with bipolar electrodes.In vivotesting on the rat sciatic nerve validated this prediction, which has not been previously reported. The accuracy of the model when compared to previous experiments, as well as the ease of use and accessibility to generate testable hypotheses, indicate that this software may represent a useful tool for a variety of nerve stimulation applications.
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Affiliation(s)
- Jesse E Bucksot
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 W Campbell Road, Richardson, TX, United States of America
| | - Collin R Chandler
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 W Campbell Road, Richardson, TX, United States of America.,Texas Biomedical Device Center, 800 W Campbell Road, Richardson, TX, United States of America
| | - Navaporn M Intharuck
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 W Campbell Road, Richardson, TX, United States of America
| | - Robert L Rennaker
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 W Campbell Road, Richardson, TX, United States of America.,The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 W Campbell Road, Richardson, TX, United States of America.,Texas Biomedical Device Center, 800 W Campbell Road, Richardson, TX, United States of America
| | - Michael P Kilgard
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 W Campbell Road, Richardson, TX, United States of America.,Texas Biomedical Device Center, 800 W Campbell Road, Richardson, TX, United States of America
| | - Seth A Hays
- The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 W Campbell Road, Richardson, TX, United States of America.,The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 W Campbell Road, Richardson, TX, United States of America.,Texas Biomedical Device Center, 800 W Campbell Road, Richardson, TX, United States of America
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25
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Pearce P, Bulluss K, Xu SS, Kim B, Milicevic M, Perera T, Thevathasan W. How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease? PLoS One 2021; 16:e0254504. [PMID: 34264988 PMCID: PMC8282046 DOI: 10.1371/journal.pone.0254504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/27/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) depends on how closely electrodes are implanted relative to an individual's ideal stimulation location. Yet, previous studies have assessed how closely electrodes are implanted relative to the planned location, after homogenizing data to a reference. Thus here, we measured how accurately electrodes are implanted relative to an ideal, dorsal STN stimulation location, assessed on each individual's native imaging. This measure captures not only the technical error of stereotactic implantation but also constraints imposed by planning a suitable trajectory. METHODS This cross-sectional study assessed 226 electrodes in 113 consecutive PD patients implanted with bilateral STN-DBS by experienced clinicians utilizing awake, microelectrode guided, surgery. The error (Euclidean distance) between the actual electrode trajectory versus a nominated ideal, dorsal STN stimulation location was determined in each hemisphere on native imaging and predictive factors sought. RESULTS The median electrode location error was 1.62 mm (IQR = 1.23 mm). This error exceeded 3 mm in 28/226 electrodes (12.4%). Location error did not differ between hemispheres implanted first or second, suggesting brain shift was minimised. Location error did not differ between electrodes positioned with (48/226), or without, a preceding microelectrode trajectory shift (suggesting such shifts were beneficial). There was no relationship between location error and case order, arguing against a learning effect. DISCUSSION/CONCLUSION The proximity of STN-DBS electrodes to a nominated ideal, dorsal STN, stimulation location is highly variable, even when implanted by experienced clinicians with brain shift minimized, and without evidence of a learning effect. Using this measure, we found that assessments on awake patients (microelectrode recordings and clinical examination) likely yielded beneficial intraoperative decisions to improve positioning. In many patients the error is likely to have reduced therapeutic efficacy. More accurate methods to implant STN-DBS electrodes relative to the ideal stimulation location are needed.
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Affiliation(s)
- Patrick Pearce
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Kristian Bulluss
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - San San Xu
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
- Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Boaz Kim
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Thushara Perera
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
| | - Wesley Thevathasan
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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26
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Shils J, Kochanski RB, Borghei A, Candocia A, Pal GD, Afshari M, Verhagen LM, Sani S. Motor Evoked Potential Recordings During Segmented Deep Brain Stimulation-A Feasibility Study. Oper Neurosurg (Hagerstown) 2021; 20:419-425. [PMID: 33428767 DOI: 10.1093/ons/opaa414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 10/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Segmented deep brain stimulation (DBS) leads, which are capable of steering current in the direction of any 1 of 3 segments, can result in a wider therapeutic window by directing current away from unintended structures, particularly, the corticospinal tract (CST). It is unclear whether the use of motor evoked potentials (MEPs) is feasible during DBS surgery via stimulation of individual contacts/segments in order to quantify CST activation thresholds and optimal contacts/segments intraoperatively. OBJECTIVE To assess the feasibility of using MEP to identify CST thresholds for ring and individual segments of the DBS lead under general anesthesia. METHODS MEP testing was performed during pulse generator implantation under general anesthesia on subjects who underwent DBS lead implantation into the subthalamic nucleus (STN). Stimulation of each ring and segmented contacts of the directional DBS lead was performed until CST threshold was reached. Stereotactic coordinates and thresholds for each contact/segment were recorded along with the initially activated muscle group. RESULTS A total of 34 hemispheres were included for analysis. MEP thresholds were recorded from 268 total contacts/segments. For segmented contacts (2 and 3, respectively), the mean highest CST thresholds were 2.33 and 2.62 mA, while the mean lowest CST thresholds were 1.7 and 1.89 mA, suggesting differential thresholds in relation to CST. First dorsal interosseous and abductor pollicis brevis (34% each) were the most commonly activated muscle groups. CONCLUSION MEP threshold recording from segmented DBS leads is feasible. MEP recordings can identify segments with highest CST thresholds and may identify segment orientation in relation to CST.
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Affiliation(s)
- Jay Shils
- Department of Anesthesia, Rush University Medical Center, Chicago, Illinois
| | - Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Alireza Borghei
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Alexander Candocia
- Department of Anesthesia, Rush University Medical Center, Chicago, Illinois
| | - Gian D Pal
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, Chicago, Illinois
| | - Mitra Afshari
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, Chicago, Illinois
| | - Leonard Metman Verhagen
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, Chicago, Illinois
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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27
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Sahyouni R, Goshtasbi K, Presacco A, Birkenbeuel J, Cheung D, Abiri A, Berger MH, Djalilian HR, Lin HW. Selective Facial Muscle Activation with Acute and Chronic Multichannel Cuff Electrode Implantation in a Feline Model. Ann Otol Rhinol Laryngol 2021; 131:365-372. [PMID: 34096343 DOI: 10.1177/00034894211023218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Facial paralysis is a debilitating condition with substantial functional and psychological consequences. This feline-model study evaluates whether facial muscles can be selectively activated in acute and chronic implantation of 16-channel multichannel cuff electrodes (MCE). METHODS Two cats underwent acute terminal MCE implantation experiments, 2 underwent chronic MCE implantation in uninjured facial nerves (FN) and tested for 6 months, and 2 underwent chronic MCE implantation experiments after FN transection injury and tested for 3 months. The MCE were wrapped around the main trunk of the skeletonized FN, and data collection consisted of EMG thresholds, amplitudes, and selectivity of muscle activation. RESULTS In acute experimentation, activation of specific channels (ie, channels 1-3 and 6-8) resulted in selective activation of orbicularis oculi, whereas activation of other channels (ie, channels 4, 5, or 8) led to selective activation of levator auris longus with higher EMG amplitudes. MCE implantation yielded stable and selective facial muscle activation EMG thresholds and amplitudes up to a 5-month period. Modest selective muscle activation was furthermore obtained after a complete transection-reapproximating nerve injury after a 3-month recovery period and implantation reoperation. Chronic implantation of MCE did not lead to fibrosis on histology. Field steering was achieved to activate distinct facial muscles by sending simultaneous subthreshold currents to multiple channels, thus theoretically protecting against nerve damage from chronic electrical stimulation. CONCLUSION Our proof-of-concept results show the ability of an MCE, supplemented with field steering, to provide a degree of selective facial muscle stimulation in a feline model, even following nerve regeneration after FN injury. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Ronald Sahyouni
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Alessandro Presacco
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.,Bio-Robotics Laboratory, Universidad Nacional Autónoma de México, Mexico
| | - Jack Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Dillon Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Michael H Berger
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.,Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
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28
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Louie KH, Petrucci MN, Grado LL, Lu C, Tuite PJ, Lamperski AG, MacKinnon CD, Cooper SE, Netoff TI. Semi-automated approaches to optimize deep brain stimulation parameters in Parkinson's disease. J Neuroeng Rehabil 2021; 18:83. [PMID: 34020662 PMCID: PMC8147513 DOI: 10.1186/s12984-021-00873-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is a treatment option for Parkinson's disease patients when medication does not sufficiently manage their symptoms. DBS can be a highly effect therapy, but only after a time-consuming trial-and-error stimulation parameter adjustment process that is susceptible to clinician bias. This trial-and-error process will be further prolonged with the introduction of segmented electrodes that are now commercially available. New approaches to optimizing a patient's stimulation parameters, that can also handle the increasing complexity of new electrode and stimulator designs, is needed. METHODS To improve DBS parameter programming, we explored two semi-automated optimization approaches: a Bayesian optimization (BayesOpt) algorithm to efficiently determine a patient's optimal stimulation parameter for minimizing rigidity, and a probit Gaussian process (pGP) to assess patient's preference. Quantified rigidity measurements were obtained using a robotic manipulandum in two participants over two visits. Rigidity was measured, in 5Hz increments, between 10-185Hz (total 30-36 frequencies) on the first visit and at eight BayesOpt algorithm-selected frequencies on the second visit. The participant was also asked their preference between the current and previous stimulation frequency. First, we compared the optimal frequency between visits with the participant's preferred frequency. Next, we evaluated the efficiency of the BayesOpt algorithm, comparing it to random and equal interval selection of frequency. RESULTS The BayesOpt algorithm estimated the optimal frequency to be the highest tolerable frequency, matching the optimal frequency found during the first visit. However, the participants' pGP models indicate a preference at frequencies between 70-110 Hz. Here the stimulation frequency is lowest that achieves nearly maximal suppression of rigidity. BayesOpt was efficient, estimating the rigidity response curve to stimulation that was almost indistinguishable when compared to the longer brute force method. CONCLUSIONS These results provide preliminary evidence of the feasibility to use BayesOpt for determining the optimal frequency, while pGP patient's preferences include more difficult to measure outcomes. Both novel approaches can shorten DBS programming and can be expanded to include multiple symptoms and parameters.
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Affiliation(s)
- Kenneth H. Louie
- Department of Biomedical Engineering, University of Minnesota, 312 Church St. SE, Minneapolis, MN 55455 US
| | - Matthew N. Petrucci
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, 55455 Minneapoli, MN US
| | - Logan L. Grado
- Department of Biomedical Engineering, University of Minnesota, 312 Church St. SE, Minneapolis, MN 55455 US
| | - Chiahao Lu
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, 55455 Minneapoli, MN US
| | - Paul J. Tuite
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, 55455 Minneapoli, MN US
| | - Andrew G. Lamperski
- Department of Electrical and Computer Engineering, University of Minnesota, 200 Union St. SE, Minneapolis, MN 55455 US
| | - Colum D. MacKinnon
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, 55455 Minneapoli, MN US
| | - Scott E. Cooper
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, 55455 Minneapoli, MN US
| | - Theoden I. Netoff
- Department of Biomedical Engineering, University of Minnesota, 312 Church St. SE, Minneapolis, MN 55455 US
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29
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Luo M, Narasimhan S, Larson PS, Martin AJ, Konrad PE, Miga MI. Impact of brain shift on neural pathways in deep brain stimulation: a preliminary analysis via multi-physics finite element models. J Neural Eng 2021; 18. [PMID: 33740780 DOI: 10.1088/1741-2552/abf066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/19/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The effectiveness of deep brain stimulation (DBS) depends on electrode placement accuracy, which can be compromised by brain shift during surgery. While there have been efforts in assessing the impact of electrode misplacement due to brain shift using preop- and postop- imaging data, such analysis using preop- and intraop- imaging data via biophysical modeling has not been conducted. This work presents a preliminary study that applies a multi-physics analysis framework using finite element biomechanical and bioelectric models to examine the impact of realistic intraoperative shift on neural pathways determined by tractography. APPROACH The study examined six patients who had undergone interventional magnetic resonance (iMR)-guided DBS surgery. The modeling framework utilized a biomechanical approach to update preoperative MR to reflect shift-induced anatomical changes. Using this anatomically deformed image and its undeformed counterpart, bioelectric effects from shifting electrode leads could be simulated and neural activation differences were approximated. Specifically, for each configuration, volume of tissue activation (VTA) was computed and subsequently used for tractography estimation. Total tract volume and overlapping volume with motor regions as well as connectivity profile were compared. In addition, volumetric overlap between different fiber bundles among configurations was computed and correlated to estimated shift. MAIN RESULT The study found deformation-induced differences in tract volume, motor region overlap, and connectivity behavior, suggesting the impact of shift. There is a strong correlation (R=-0.83) between shift from intended target and intended neural pathway recruitment, where at threshold of ~2.94 mm, intended recruitment completely degrades. The determined threshold is consistent with and provides quantitative support to prior observations and literature that deviations of 2-3 mm are detrimental. SIGNIFICANCE The findings support and advance prior studies and understanding to illustrate the need to account for shift in DBS and the potentiality of computational modeling for estimating influence of shift on neural activation.
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Affiliation(s)
- Ma Luo
- Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, Tennessee, 37232, UNITED STATES
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Nashville, Tennessee, 37212, UNITED STATES
| | - Paul S Larson
- Department of Neurological Surgery, University of California San Francisco, Box 0112, 505 Parnassus Ave, Room M779, San Francisco, California, 94143, UNITED STATES
| | - Alastiar J Martin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California, 94143, UNITED STATES
| | - Peter E Konrad
- Department of Neurosurgery, West Virginia University, PO Box 9183, Morgantown, West Virginia, 26506, UNITED STATES
| | - Michael I Miga
- Department of Biomedical Engineering, Vanderbilt University, 5901 Stevenson Center, Nashville, Tennessee, 37235, UNITED STATES
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Khaledi-Nasab A, Kromer JA, Tass PA. Long-Lasting Desynchronization of Plastic Neural Networks by Random Reset Stimulation. Front Physiol 2021; 11:622620. [PMID: 33613303 PMCID: PMC7893102 DOI: 10.3389/fphys.2020.622620] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022] Open
Abstract
Excessive neuronal synchrony is a hallmark of neurological disorders such as epilepsy and Parkinson's disease. An established treatment for medically refractory Parkinson's disease is high-frequency (HF) deep brain stimulation (DBS). However, symptoms return shortly after cessation of HF-DBS. Recently developed decoupling stimulation approaches, such as Random Reset (RR) stimulation, specifically target pathological connections to achieve long-lasting desynchronization. During RR stimulation, a temporally and spatially randomized stimulus pattern is administered. However, spatial randomization, as presented so far, may be difficult to realize in a DBS-like setup due to insufficient spatial resolution. Motivated by recently developed segmented DBS electrodes with multiple stimulation sites, we present a RR stimulation protocol that copes with the limited spatial resolution of currently available depth electrodes for DBS. Specifically, spatial randomization is realized by delivering stimuli simultaneously to L randomly selected stimulation sites out of a total of M stimulation sites, which will be called L/M-RR stimulation. We study decoupling by L/M-RR stimulation in networks of excitatory integrate-and-fire neurons with spike-timing dependent plasticity by means of theoretical and computational analysis. We find that L/M-RR stimulation yields parameter-robust decoupling and long-lasting desynchronization. Furthermore, our theory reveals that strong high-frequency stimulation is not suitable for inducing long-lasting desynchronization effects. As a consequence, low and high frequency L/M-RR stimulation affect synaptic weights in qualitatively different ways. Our simulations confirm these predictions and show that qualitative differences between low and high frequency L/M-RR stimulation are present across a wide range of stimulation parameters, rendering stimulation with intermediate frequencies most efficient. Remarkably, we find that L/M-RR stimulation does not rely on a high spatial resolution, characterized by the density of stimulation sites in a target area, corresponding to a large M. In fact, L/M-RR stimulation with low resolution performs even better at low stimulation amplitudes. Our results provide computational evidence that L/M-RR stimulation may present a way to exploit modern segmented lead electrodes for long-lasting therapeutic effects.
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Affiliation(s)
- Ali Khaledi-Nasab
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Justus A Kromer
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
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31
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Yalaz M, Noor S, McIntyre C, Butz M, Schnitzler A, Deuschl G, Höft M. DBS electrode localization and rotational orientation detection using SQUID-based magnetoencephalography. J Neural Eng 2021; 18. [PMID: 33503598 DOI: 10.1088/1741-2552/abe099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/27/2021] [Indexed: 11/12/2022]
Abstract
The aim of the present study was to investigate the accuracy of localization and rotational orientation detection of a directional deep brain stimulation (DBS) electrode using a state-of-the-art magnetoencephalography (MEG) scanner. A directional DBS electrode along with its stimulator was integrated into a head phantom and placed inside the MEG sensor array. The electrode was comprised of six directional and two omnidirectional contacts. Measurements were performed while stimulating with different contacts and parameters in the phantom. Finite element modeling and fitting approach were used to compute electrode position and orientation. The electrode was localized with a mean accuracy of 2.2 mm while orientation was determined with a mean accuracy of 11°. The limitation in detection accuracy was due to the lower measurement precision of the MEG system. Considering an ideal measurement condition, these values represent the lower bound of accuracy that can be achieved in patients. However, a future magnetic measuring system with higher precision will potentially detect location and orientation of a DBS electrode with an even increased accuracy.
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Affiliation(s)
- Mevlüt Yalaz
- Christian-Albrechts-Universität zu Kiel, Kaiserstrasse 2, Kiel, Schleswig-Holstein, 24143, GERMANY
| | - Sohail Noor
- Case Western Reserve University, 2103 Cornell Road, Cleveland, Ohio, 44106, UNITED STATES
| | - Cameron McIntyre
- Case Western Reserve University, 2103 Cornell Road, Cleveland, Ohio, 44106, UNITED STATES
| | - Markus Butz
- Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf, Nordrhein-Westfalen, 40225, GERMANY
| | - Alfons Schnitzler
- Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf, Nordrhein-Westfalen, 40225, GERMANY
| | - Gunther Deuschl
- Department of Neurology, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Straße 3, Kiel, Schleswig-Holstein, 24105, GERMANY
| | - Michael Höft
- Christian-Albrechts-Universität zu Kiel, Kaiserstrasse 2, Kiel, Schleswig-Holstein, 24143, GERMANY
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32
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Greiner N, Barra B, Schiavone G, Lorach H, James N, Conti S, Kaeser M, Fallegger F, Borgognon S, Lacour S, Bloch J, Courtine G, Capogrosso M. Recruitment of upper-limb motoneurons with epidural electrical stimulation of the cervical spinal cord. Nat Commun 2021; 12:435. [PMID: 33469022 PMCID: PMC7815834 DOI: 10.1038/s41467-020-20703-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022] Open
Abstract
Epidural electrical stimulation (EES) of lumbosacral sensorimotor circuits improves leg motor control in animals and humans with spinal cord injury (SCI). Upper-limb motor control involves similar circuits, located in the cervical spinal cord, suggesting that EES could also improve arm and hand movements after quadriplegia. However, the ability of cervical EES to selectively modulate specific upper-limb motor nuclei remains unclear. Here, we combined a computational model of the cervical spinal cord with experiments in macaque monkeys to explore the mechanisms of upper-limb motoneuron recruitment with EES and characterize the selectivity of cervical interfaces. We show that lateral electrodes produce a segmental recruitment of arm motoneurons mediated by the direct activation of sensory afferents, and that muscle responses to EES are modulated during movement. Intraoperative recordings suggested similar properties in humans at rest. These modelling and experimental results can be applied for the development of neurotechnologies designed for the improvement of arm and hand control in humans with quadriplegia. The efficacy of epidural electrical stimulation (EES) to engage arm muscles and improve movement after spinal cord injury is still unclear. Here, the authors investigated how EES can recruit upper-limb motor neurons by combining computational modelling with experiments in non-human primates.
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Affiliation(s)
- Nathan Greiner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland. .,Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
| | - Beatrice Barra
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Henri Lorach
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland
| | - Nicholas James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Sara Conti
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Melanie Kaeser
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Simon Borgognon
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Stéphanie Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marco Capogrosso
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland. .,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. .,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
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33
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Baniasadi M, Proverbio D, Gonçalves J, Hertel F, Husch A. FastField: An open-source toolbox for efficient approximation of deep brain stimulation electric fields. Neuroimage 2020; 223:117330. [DOI: 10.1016/j.neuroimage.2020.117330] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/26/2020] [Accepted: 08/25/2020] [Indexed: 01/25/2023] Open
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van Wouwe NC, Neimat JS, van den Wildenberg WPM, Hughes SB, Lopez AM, Phibbs FT, Schall JD, Rodriguez WJ, Bradley EB, Dawant BM, Wylie SA. Subthalamic Nucleus Subregion Stimulation Modulates Inhibitory Control. Cereb Cortex Commun 2020; 1:tgaa083. [PMID: 33381760 PMCID: PMC7750129 DOI: 10.1093/texcom/tgaa083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/12/2022] Open
Abstract
Patients with Parkinson's disease (PD) often experience reductions in the proficiency to inhibit actions. The motor symptoms of PD can be effectively treated with deep brain stimulation (DBS) of the subthalamic nucleus (STN), a key structure in the frontal-striatal network that may be directly involved in regulating inhibitory control. However, the precise role of the STN in stopping control is unclear. The STN consists of functional subterritories linked to dissociable cortical networks, although the boundaries of the subregions are still under debate. We investigated whether stimulating the dorsal and ventral subregions of the STN would show dissociable effects on ability to stop. We studied 12 PD patients with STN DBS. Patients with two adjacent contacts positioned within the bounds of the dorsal and ventral STN completed two testing sessions (OFF medication) with low amplitude stimulation (0.4 mA) at either the dorsal or ventral contacts bilaterally, while performing the stop task. Ventral, but not dorsal, DBS improved stopping latencies. Go reactions were similar between dorsal and ventral DBS STN. Stimulation in the ventral, but not dorsal, subregion of the STN improved stopping speed, confirming the involvement of the STN in stopping control and supporting the STN functional subregions.
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Affiliation(s)
- Nelleke C van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202 USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202 USA
| | - Wery P M van den Wildenberg
- Department of Psychology, University of Amsterdam, Amsterdam 1018 WS, The Netherlands
- Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam 1001 NK, The Netherlands
| | - Shelby B Hughes
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Alexander M Lopez
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jeffrey D Schall
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - William J Rodriguez
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Elise B Bradley
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Scott A Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202 USA
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Juárez-Paz LM. In silico Accuracy and Energy Efficiency of Two Steering Paradigms in Directional Deep Brain Stimulation. Front Neurol 2020; 11:593798. [PMID: 33193061 PMCID: PMC7661934 DOI: 10.3389/fneur.2020.593798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 01/11/2023] Open
Abstract
Background: In Deep Brain Stimulation (DBS), stimulation field steering is used to achieve stimulation spatial specificity, which is critical to obtain clinical benefits and avoid side effects. Multiple Independent Current Control (MICC) and Interleaving/Multi Stim Set (Interleaving/MSS) are two stimulation field steering paradigms in commercially available DBS systems. This work investigates the stimulation field steering accuracy and energy efficiency of these two paradigms in directional DBS. Methods: Volumes of Tissue Activated (VTAs) were generated in silico using pulse widths of 60 μs and five pulse amplitude fractionalizations intended to steer the VTAs radially in 12° steps. For each fractionalization, VTAs were generated with nine pre-defined target radii. Stimulation field steering accuracy was assessed based on the VTAs rotation angle. Energy efficiency was inferred from current draw from battery values, which were calculated based on the pulse amplitudes needed to generate and steer the VTAs, as well as electrode impedance measurements of clinically implanted directional leads. Results: For radial steering, MICC needed a single VTA. In contrast, Interleaving/MSS required the generation of two VTAs, whose union and intersection created an Interleaving/MSS VTA and an Intersection VTA, respectively. MICC VTAs were 6.8 (−3.2–11.8)% larger than Interleaving/MSS VTAs. The Intersection VTAs accounted for 26.2 (16.0–32.8)% of Interleaving/MSS VTAs and were exposed to a higher stimulation frequency. For all VTA radius-fractionalization combinations, steering accuracy was 7.0 (4.5–10.5)° for MICC and 24.0 (9.0–25.3)° for Interleaving/MSS. Pulse amplitudes were 16.1 (9.2–28.6)% lower for MICC than for Interleaving/MSS, leading to a 45.9 (18.8–72.6)% lower current draw from battery for MICC. Conclusions: The results of this work show that in silico, MICC achieves a significantly better stimulation field steering accuracy and has a significantly higher energy efficiency than Interleaving/MSS. Although direct evidence still needs to be generated to translate the results of this work to clinical practice, clinical outcomes may profit from the better stimulation field steering accuracy of MICC and longevity of DBS systems may profit from its higher energy efficiency.
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Affiliation(s)
- León Mauricio Juárez-Paz
- Neuromodulation Research and Advanced Concepts, Boston Scientific Corporation, Valencia, CA, United States
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36
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Shah NP, Chichilnisky EJ. Computational challenges and opportunities for a bi-directional artificial retina. J Neural Eng 2020; 17:055002. [PMID: 33089827 DOI: 10.1088/1741-2552/aba8b1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A future artificial retina that can restore high acuity vision in blind people will rely on the capability to both read (observe) and write (control) the spiking activity of neurons using an adaptive, bi-directional and high-resolution device. Although current research is focused on overcoming the technical challenges of building and implanting such a device, exploiting its capabilities to achieve more acute visual perception will also require substantial computational advances. Using high-density large-scale recording and stimulation in the primate retina with an ex vivo multi-electrode array lab prototype, we frame several of the major computational problems, and describe current progress and future opportunities in solving them. First, we identify cell types and locations from spontaneous activity in the blind retina, and then efficiently estimate their visual response properties by using a low-dimensional manifold of inter-retina variability learned from a large experimental dataset. Second, we estimate retinal responses to a large collection of relevant electrical stimuli by passing current patterns through an electrode array, spike sorting the resulting recordings and using the results to develop a model of evoked responses. Third, we reproduce the desired responses for a given visual target by temporally dithering a diverse collection of electrical stimuli within the integration time of the visual system. Together, these novel approaches may substantially enhance artificial vision in a next-generation device.
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Affiliation(s)
- Nishal P Shah
- Department of Electrical Engineering, Stanford University, Stanford, CA, United States of America. Hansen Experimental Physics Laboratory, Stanford University, Stanford, CA, United States of America. Department of Neurosurgery, Stanford University, Stanford, CA, United States of America. Author to whom any correspondence should be addressed
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37
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Vissani M, Isaias IU, Mazzoni A. Deep brain stimulation: a review of the open neural engineering challenges. J Neural Eng 2020; 17:051002. [PMID: 33052884 DOI: 10.1088/1741-2552/abb581] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an established and valid therapy for a variety of pathological conditions ranging from motor to cognitive disorders. Still, much of the DBS-related mechanism of action is far from being understood, and there are several side effects of DBS whose origin is unclear. In the last years DBS limitations have been tackled by a variety of approaches, including adaptive deep brain stimulation (aDBS), a technique that relies on using chronically implanted electrodes on 'sensing mode' to detect the neural markers of specific motor symptoms and to deliver on-demand or modulate the stimulation parameters accordingly. Here we will review the state of the art of the several approaches to improve DBS and summarize the main challenges toward the development of an effective aDBS therapy. APPROACH We discuss models of basal ganglia disorders pathogenesis, hardware and software improvements for conventional DBS, and candidate neural and non-neural features and related control strategies for aDBS. MAIN RESULTS We identify then the main operative challenges toward optimal DBS such as (i) accurate target localization, (ii) increased spatial resolution of stimulation, (iii) development of in silico tests for DBS, (iv) identification of specific motor symptoms biomarkers, in particular (v) assessing how LFP oscillations relate to behavioral disfunctions, and (vi) clarify how stimulation affects the cortico-basal-ganglia-thalamic network to (vii) design optimal stimulation patterns. SIGNIFICANCE This roadmap will lead neural engineers novel to the field toward the most relevant open issues of DBS, while the in-depth readers might find a careful comparison of advantages and drawbacks of the most recent attempts to improve DBS-related neuromodulatory strategies.
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Affiliation(s)
- Matteo Vissani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025 Pisa, Italy. Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
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Zhang S, Tagliati M, Pouratian N, Cheeran B, Ross E, Pereira E. Steering the Volume of Tissue Activated With a Directional Deep Brain Stimulation Lead in the Globus Pallidus Pars Interna: A Modeling Study With Heterogeneous Tissue Properties. Front Comput Neurosci 2020; 14:561180. [PMID: 33101000 PMCID: PMC7546409 DOI: 10.3389/fncom.2020.561180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/20/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: To study the effect of directional deep brain stimulation (DBS) electrode configuration and vertical electrode spacing on the volume of tissue activated (VTA) in the globus pallidus, pars interna (GPi). Background: Directional DBS leads may allow clinicians to precisely direct current fields to different functional networks within traditionally targeted brain areas. Modeling the shape and size of the VTA for various monopolar or bipolar configurations can inform clinical programming strategies for GPi DBS. However, many computational models of VTA are limited by assuming tissue homogeneity. Methods: We generated a multimodal image-based detailed anatomical (MIDA) computational model with a directional DBS lead (1.5 mm or 0.5 mm vertical electrode spacing) placed with segmented contact 2 at the ventral posterolateral "sensorimotor" region of the GPi. The effect of tissue heterogeneity was examined by replacing the MIDA tissues with a homogeneous tissue of conductance 0.3 S/m. DBS pulses (amplitude: 1 mA, pulse width: 60 μs, frequency: 130 Hz) were used to produce VTAs. The following DBS contact configurations were tested: single-segment monopole (2B-/Case+), two-segment monopole (2A-/2B-/Case+ and 2B-/3B-/Case+), ring monopole (2A-/2B-/2C-/Case+), one-cathode three-anode bipole (2B-/3A+/3B+/3C+), three-cathode three-anode bipole (2A-/2B-/2C-/3A+/3B+/3C+). Additionally, certain vertical configurations were repeated with 2 mA current amplitude. Results: Using a heterogeneous tissue model affected both the size and shape of the VTA in GPi. Electrodes with both 0.5 mm and 1.5 mm vertical spacing (1 mA) modeling showed that the single segment monopolar VTA was entirely contained within the GPi when the active electrode is placed at the posterolateral "sensorimotor" GPi. Two segments in a same ring and ring settings, however, produced VTAs outside of the GPi border that spread into adjacent white matter pathways, e.g., optic tract and internal capsule. Both stacked monopolar settings and vertical bipolar settings allowed activation of structures dorsal to the GPi in addition to the GPi. Modeling of the stacked monopolar settings with the DBS lead with 0.5 mm vertical electrode spacing further restricted VTAs within the GPi, but the VTA volumes were smaller compared to the equivalent settings of 1.5 mm spacing.
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Affiliation(s)
- Simeng Zhang
- Neuromodulation Division, Abbott, Plano, TX, United States
| | | | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Binith Cheeran
- Neuromodulation Division, Abbott, Plano, TX, United States
| | - Erika Ross
- Neuromodulation Division, Abbott, Plano, TX, United States
| | - Erlick Pereira
- Research Institute of Molecular and Clinical Sciences, St. George's University of London, London, United Kingdom
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Slopsema JP, Canna A, Uchenik M, Lehto LJ, Krieg J, Wilmerding L, Koski DM, Kobayashi N, Dao J, Blumenfeld M, Filip P, Min HK, Mangia S, Johnson MD, Michaeli S. Orientation-selective and directional deep brain stimulation in swine assessed by functional MRI at 3T. Neuroimage 2020; 224:117357. [PMID: 32916285 PMCID: PMC7783780 DOI: 10.1016/j.neuroimage.2020.117357] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/16/2022] Open
Abstract
Functional MRI (fMRI) has become an important tool for probing network-level effects of deep brain stimulation (DBS). Previous DBS-fMRI studies have shown that electrical stimulation of the ventrolateral (VL) thalamus can modulate sensorimotor cortices in a frequency and amplitude dependent manner. Here, we investigated, using a swine animal model, how the direction and orientation of the electric field, induced by VL-thalamus DBS, affects activity in the sensorimotor cortex. Adult swine underwent implantation of a novel 16-electrode (4 rows × 4 columns) directional DBS lead in the VL thalamus. A within-subject design was used to compare fMRI responses for (1) directional stimulation consisting of monopolar stimulation in four radial directions around the DBS lead, and (2) orientation-selective stimulation where an electric field dipole was rotated 0°−360° around a quadrangle of electrodes. Functional responses were quantified in the premotor, primary motor, and somatosensory cortices. High frequency electrical stimulation through leads implanted in the VL thalamus induced directional tuning in cortical response patterns to varying degrees depending on DBS lead position. Orientation-selective stimulation showed maximal functional response when the electric field was oriented approximately parallel to the DBS lead, which is consistent with known axonal orientations of the cortico-thalamocortical pathway. These results demonstrate that directional and orientation-selective stimulation paradigms in the VL thalamus can tune network-level modulation patterns in the sensorimotor cortex, which may have translational utility in improving functional outcomes of DBS therapy.
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Affiliation(s)
| | - Antonietta Canna
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota
| | | | - Lauri J Lehto
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota
| | - Jordan Krieg
- Department of Biomedical Engineering, University of Minnesota
| | | | - Dee M Koski
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota
| | - Naoharu Kobayashi
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota
| | - Joan Dao
- Department of Biomedical Engineering, University of Minnesota
| | | | - Pavel Filip
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota; Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | | | - Silvia Mangia
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota; Institute for Translational Neuroscience, University of Minnesota
| | - Shalom Michaeli
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota.
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40
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Paff M, Loh A, Sarica C, Lozano AM, Fasano A. Update on Current Technologies for Deep Brain Stimulation in Parkinson's Disease. J Mov Disord 2020; 13:185-198. [PMID: 32854482 PMCID: PMC7502302 DOI: 10.14802/jmd.20052] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 01/19/2023] Open
Abstract
Deep brain stimulation (DBS) is becoming increasingly central in the treatment of patients with Parkinson's disease and other movement disorders. Recent developments in DBS lead and implantable pulse generator design provide increased flexibility for programming, potentially improving the therapeutic benefit of stimulation. Directional DBS leads may increase the therapeutic window of stimulation by providing a means of avoiding current spread to structures that might give rise to stimulation-related side effects. Similarly, control of current to individual contacts on a DBS lead allows for shaping of the electric field produced between multiple active contacts. The following review aims to describe the recent developments in DBS system technology and the features of each commercially available DBS system. The advantages of each system are reviewed, and general considerations for choosing the most appropriate system are discussed.
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Affiliation(s)
- Michelle Paff
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Can Sarica
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Canada
- Krembil Brain Institute, Toronto, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
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41
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Béreau M, Kibleur A, Bouthour W, Tomkova Chaoui E, Maling N, Nguyen TAK, Momjian S, Vargas Gomez MI, Zacharia A, Bally JF, Fleury V, Tatu L, Burkhard PR, Krack P. Modeling of Electric Fields in Individual Imaging Atlas for Capsular Threshold Prediction of Deep Brain Stimulation in Parkinson's Disease: A Pilot Study. Front Neurol 2020; 11:532. [PMID: 32714264 PMCID: PMC7343907 DOI: 10.3389/fneur.2020.00532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Modeling of deep brain stimulation electric fields and anatomy-based software might improve post-operative management of patients with Parkinson's disease (PD) who have benefitted from subthalamic nucleus deep brain stimulation (STN-DBS). Objective: We compared clinical and software-guided determination of the thresholds for current diffusion to the pyramidal tract, the most frequent limiting side effect in post-operative management of STN-DBS PD patients. Methods: We assessed monopolar reviews in 16 consecutive STN-DBS PD patients and retrospectively compared clinical capsular thresholds, which had been assessed according to standard clinical practice, to those predicted by volume of tissue activated (VTA) model software. All the modeling steps were performed blinded from patients' clinical evaluations. Results: At the group level, we found a significant correlation (p = 0.0001) when performing statistical analysis on the z-scored capsular thresholds, but with a low regression coefficient (r = 0.2445). When considering intra-patient analysis, we found significant correlations (p < 0.05) between capsular threshold as modeled with the software and capsular threshold as determined clinically in five patients (31.2%). Conclusions: In this pilot study, the VTA model software was of limited assistance in identifying capsular thresholds for the whole cohort due to a large inter-patient variability. Clinical testing remains the gold standard in selecting stimulation parameters for STN-DBS in PD.
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Affiliation(s)
- Matthieu Béreau
- Department of Neurology, Besançon University Hospital, Besançon, France.,Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Astrid Kibleur
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Walid Bouthour
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | | | | | - T A Khoa Nguyen
- Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - Shahan Momjian
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland
| | | | - André Zacharia
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Julien F Bally
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Vanessa Fleury
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Laurent Tatu
- Department of Neurology, Besançon University Hospital, Besançon, France
| | - Pierre R Burkhard
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Paul Krack
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland.,Department of Neurology, Bern University Hospital, Bern, Switzerland
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42
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Coventry BS, Sick JT, Talavage TM, Stantz KM, Bartlett EL. Short-wave Infrared Neural Stimulation Drives Graded Sciatic Nerve Activation Across A Continuum of Wavelengths. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3581-3585. [PMID: 33018777 DOI: 10.1109/embc44109.2020.9176177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Infrared neural stimulation (INS) is an optical stimulation technique which uses coherent light to stimulate nerves and neurons and which shows increased spatial selectivity compared to electrical stimulation. This could improve deep brain, high channel count, or vagus nerve stimulation. In this study, we seek to understand the wavelength dependence of INS in the near-infrared optical window. Rat sciatic nerves were excised ex vivo and stimulated with wavelengths between 700 and 900 nm. Recorded compound nerve action potentials (CNAPs) showed that stimulation was maximized in the 700 nm window despite comparable laser power levels across wavelengths. Computational models demonstrated that wavelength-based activation dependencies were not a result of passive optical properties. This data demonstrates that INS is both wavelength and power level dependent, which inform stimulation systems to actively target neural microcircuits in humans.
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43
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Richardson RT, Ibbotson MR, Thompson AC, Wise AK, Fallon JB. Optical stimulation of neural tissue. Healthc Technol Lett 2020; 7:58-65. [PMID: 32754339 PMCID: PMC7353819 DOI: 10.1049/htl.2019.0114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022] Open
Abstract
Electrical stimulation has been used for decades in devices such as pacemakers, cochlear implants and more recently for deep brain and retinal stimulation and electroceutical treatment of disease. However, current spread from the electrodes limits the precision of neural activation, leading to a low quality therapeutic outcome or undesired side-effects. Alternative methods of neural stimulation such as optical stimulation offer the potential to deliver higher spatial resolution of neural activation. Direct optical stimulation is possible with infrared light, while visible light can be used to activate neurons if the neural tissue is genetically modified with a light sensitive ion channel. Experimentally, both methods have resulted in highly precise stimulation with little spread of activation at least in the cochlea, each with advantages and disadvantages. Infrared neural stimulation does not require modification of the neural tissue, but has very high power requirements. Optogenetics can achieve precision of activation with lower power, but only in conjunction with targeted insertion of a light sensitive ion channel into the nervous system via gene therapy. This review will examine the advantages and limitations of optical stimulation of neural tissue, using the cochlea as an exemplary model and recent developments for retinal and deep brain stimulation.
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Affiliation(s)
- Rachael Theresa Richardson
- Bionics Institute, Melbourne 3002, Australia.,University of Melbourne, Medical Bionics Department, Melbourne, 3002, Australia.,University of Melbourne, Department of Surgery (Otolaryngology), Melbourne, 3002, Australia
| | - Michael R Ibbotson
- National Vision Research Institute, Australian College of Optometry, and Department of Optometry and Vision Science, University of Melbourne, Melbourne, Australia
| | | | - Andrew K Wise
- Bionics Institute, Melbourne 3002, Australia.,University of Melbourne, Medical Bionics Department, Melbourne, 3002, Australia.,University of Melbourne, Department of Surgery (Otolaryngology), Melbourne, 3002, Australia
| | - James B Fallon
- Bionics Institute, Melbourne 3002, Australia.,University of Melbourne, Medical Bionics Department, Melbourne, 3002, Australia.,University of Melbourne, Department of Surgery (Otolaryngology), Melbourne, 3002, Australia
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44
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Rustogi P, Judy JW. Electrical Isolation Performance of Microgasket Technology for Implant Packaging. ... ELECTRONIC COMPONENTS & TECHNOLOGY CONFERENCE. ELECTRONIC COMPONENTS & TECHNOLOGY CONFERENCE 2020; 2020:1601-1607. [PMID: 35586778 PMCID: PMC9112188 DOI: 10.1109/ectc32862.2020.00251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
High-channel-count neural interfaces are typically packaged by being permanently bonded to their packaged electronics followed by encapsulation. Such interfaces are often intimately integrated into neural tissue, their removal to replace the battery or upgrade electronics is not undesirable. Gaskets are widely used to provide liquid/electrical isolation and to seal the connection between two or more mating parts. Pressure-driven microgaskets are well established in the field of microfluidics. Although rematable microgaskets for fluidic interconnects exist, the use of microgaskets for electrical isolation have not been demonstrated. Our approach is to electrically isolate 2-D arrays of contact pads using a compressible silicone microgasket. Electrochemical impedance spectroscopy (EIS) was used to quantify the electrical isolation of the microgasket on contact pads, which were formed in a polyimide flex circuit, as a function of frequency after being soaked in saline. Experiments have shown that the compressed sub-millimeter PDMSe microgasket can provide excellent isolation (i.e., >30 MΩ at 1 KHz) that is comparable to the other more conventional packaging methods, such as encapsulation in polydimethylsiloxane elastomer (PDMSe) or parylene-C. Our microgasket-based approach should be scalable to high channel counts and high channel densities enabling much smaller and higher-performance neural implants.
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Affiliation(s)
- Paritosh Rustogi
- Electrical and Computer Engineering Department, Nanoscience Institute for Medical and Engineering Technology, University of Florida, Gainesville, USA
| | - Jack W Judy
- Electrical and Computer Engineering Department, Nanoscience Institute for Medical and Engineering Technology, University of Florida, Gainesville, USA
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45
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Hui D, Murgai AA, Gilmore G, Mohideen SI, Parrent AG, Jog MS. Assessing the effect of current steering on the total electrical energy delivered and ambulation in Parkinson's disease. Sci Rep 2020; 10:8256. [PMID: 32427934 PMCID: PMC7237436 DOI: 10.1038/s41598-020-64250-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/06/2020] [Indexed: 11/09/2022] Open
Abstract
Vertical current steering (vCS) divides current between multiple contacts, which reduces radial spread to fine-tune the electric field shape and improves neuroanatomical targeting. vCS may improve the variable responsiveness of Parkinsonian gait to conventional deep brain stimulation. We hypothesized that vCS elicits greater improvement in ambulation in Parkinson’s disease patients compared to conventional, single-contact stimulation. vCS was implemented with divisions of 70%/30% and 50%/50% and compared to single-contact stimulation with four therapeutic window amplitudes in current-controlled systems. Walking at a self-selected pace was evaluated in seven levodopa-responsive patients. Integrative measures of gait and stimulation parameters were assessed with the functional ambulation performance (FAP) score and total electrical energy delivered (TEED), respectively. A two-tailed Wilcoxon matched-pairs signed rank test assessed the effect of each stimulation condition on FAP and TEED and compared regression slopes; further, a two-tailed Spearman test identified correlations. vCS significantly lowered the TEED (P < 0.0001); however, FAP scores were not different between conditions (P = 0.786). Compared to single-contact stimulation, vCS elicited higher FAP scores with lower TEED (P = 0.031). FAP and TEED were positively correlated in vCS (P = 2.000 × 10-5, r = 0.397) and single-contact stimulation (P = 0.034, r = 0.205). Therefore, vCS and single-contact stimulation improved ambulation similarly but vCS reduced the TEED and side-effects at higher amplitudes.
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Affiliation(s)
- Daphne Hui
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5C1, Canada.
| | - Aditya A Murgai
- Department of Clinical Neurological Sciences, Western University, London, ON, N6A 3K7, Canada
| | - Greydon Gilmore
- Department of Clinical Neurological Sciences, Western University, London, ON, N6A 3K7, Canada.,School of Biomedical Engineering, Western University, London, ON, N6A 3K7, Canada
| | - Shabna I Mohideen
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5C1, Canada
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences, Western University, London, ON, N6A 3K7, Canada
| | - Mandar S Jog
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5C1, Canada.,Department of Clinical Neurological Sciences, Western University, London, ON, N6A 3K7, Canada.,School of Biomedical Engineering, Western University, London, ON, N6A 3K7, Canada
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46
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Modeling and simulation of deep brain stimulation electrodes with various active contacts. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42600-020-00060-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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47
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Janson AP, Anderson DN, Butson CR. Activation robustness with directional leads and multi-lead configurations in deep brain stimulation. J Neural Eng 2020; 17:026012. [PMID: 32116233 PMCID: PMC7405888 DOI: 10.1088/1741-2552/ab7b1d] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Clinical outcomes from deep brain stimulation (DBS) can be highly variable, and two critical factors underlying this variability are the location and type of stimulation. In this study we quantified how robustly DBS activates a target region when taking into account a range of different lead designs and realistic variations in placement. The objective of the study is to assess the likelihood of achieving target activation. APPROACH We performed finite element computational modeling and established a metric of performance robustness to evaluate the ability of directional and multi-lead configurations to activate target fiber pathways while taking into account location variability. A more robust lead configuration produces less variability in activation across all stimulation locations around the target. MAIN RESULTS Directional leads demonstrated higher overall performance robustness compared to axisymmetric leads, primarily 1-2 mm outside of the target. Multi-lead configurations demonstrated higher levels of robustness compared to any single lead due to distribution of electrodes in a broader region around the target. SIGNIFICANCE Robustness measures can be used to evaluate the performance of existing DBS lead designs and aid in the development of novel lead designs to better accommodate known variability in lead location and orientation. This type of analysis may also be useful to understand how DBS clinical outcome variability is influenced by lead location among groups of patients.
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Affiliation(s)
- Andrew P Janson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States of America. Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, UT, United States of America
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48
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Lehto LJ, Canna A, Wu L, Sierra A, Zhurakovskaya E, Ma J, Pearce C, Shaio M, Filip P, Johnson MD, Low WC, Gröhn O, Tanila H, Mangia S, Michaeli S. Orientation selective deep brain stimulation of the subthalamic nucleus in rats. Neuroimage 2020; 213:116750. [PMID: 32198048 DOI: 10.1016/j.neuroimage.2020.116750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/22/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022] Open
Abstract
Deep brain stimulation (DBS) has become an important tool in the management of a wide spectrum of diseases in neurology and psychiatry. Target selection is a vital aspect of DBS so that only the desired areas are stimulated. Segmented leads and current steering have been shown to be promising additions to DBS technology enabling better control of the stimulating electric field. Recently introduced orientation selective DBS (OS-DBS) is a related development permitting sensitization of the stimulus to axonal pathways with different orientations by freely controlling the primary direction of the electric field using multiple contacts. Here, we used OS-DBS to stimulate the subthalamic nucleus (STN) in healthy rats while simultaneously monitoring the induced brain activity with fMRI. Maximal activation of the sensorimotor and basal ganglia-thalamocortical networks was observed when the electric field was aligned mediolaterally in the STN pointing in the lateral direction, while no cortical activation was observed with the electric field pointing medially to the opposite direction. Such findings are consistent with mediolateral main direction of the STN fibers, as seen with high resolution diffusion imaging and histology. The asymmetry of the OS-DBS dipolar field distribution using three contacts along with the potential stimulation of the internal capsule, are also discussed. We conclude that OS-DBS offers an additional degree of flexibility for optimization of DBS of the STN which may enable a better treatment response.
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Affiliation(s)
- Lauri J Lehto
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Antonietta Canna
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Lin Wu
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ekaterina Zhurakovskaya
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA; A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jun Ma
- Department of Neurosurgery, University of Minnesota, Minneapolis, USA
| | - Clairice Pearce
- Department of Neurosurgery, University of Minnesota, Minneapolis, USA
| | - Maple Shaio
- Department of Neurosurgery, University of Minnesota, Minneapolis, USA
| | - Pavel Filip
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA; First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Walter C Low
- Department of Neurosurgery, University of Minnesota, Minneapolis, USA
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Heikki Tanila
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Silvia Mangia
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Shalom Michaeli
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.
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49
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Preston C, Alvarez AM, Barragan A, Becker J, Kasoff WS, Witte RS. High resolution transcranial acoustoelectric imaging of current densities from a directional deep brain stimulator. J Neural Eng 2020; 17:016074. [PMID: 31978914 PMCID: PMC7446234 DOI: 10.1088/1741-2552/ab6fc3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE New innovations in deep brain stimulation (DBS) enable directional current steering-allowing more precise electrical stimulation of the targeted brain structures for Parkinson's disease, essential tremor and other neurological disorders. While intra-operative navigation through MRI or CT approaches millimeter accuracy for placing the DBS leads, no existing modality provides feedback of the currents as they spread from the contacts through the brain tissue. In this study, we investigate transcranial acoustoelectric imaging (tAEI) as a new modality to non-invasively image and characterize current produced from a directional DBS lead. tAEI uses ultrasound (US) to modulate tissue resistivity to generate detectable voltage signals proportional to the local currents. APPROACH An 8-channel directional DBS lead (Infinity 6172ANS, Abbott Inc) was inserted inside three adult human skulls submerged in 0.9% NaCl. A 2.5 MHz linear array delivered US pulses through the transtemporal window and focused near the contacts on the lead, while a custom amplifier and acquisition system recorded the acoustoelectric (AE) interaction used to generate images. MAIN RESULTS tAEI detected monopolar current with stimulation pulses as short as 100 µs with an SNR ranging from 10-27 dB when using safe US pressure (mechanical indices <0.78) and injected current of ~2 mA peak amplitude. Adjacent contacts were discernable along the length and within each ring of the lead with a mean radial separation between contacts of 2.10 and 1.34 mm, respectively. SIGNIFICANCE These results demonstrate the feasibility of tAEI for high resolution mapping of directional DBS currents using clinically-relevant stimulation parameters. This new modality may improve the accuracy for placing the DBS leads, guide calibration and programming, and monitor long-term performance of DBS for treatment of Parkinson's disease.
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Affiliation(s)
- Chet Preston
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States of America
| | - Alexander M Alvarez
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States of America
| | - Andres Barragan
- Department of Computer Science, University of Arizona, Tucson, AZ, United States of America
| | - Jennifer Becker
- Department of Medical Imaging, University of Arizona, Tucson, AZ, United States of America
| | - Willard S Kasoff
- Department of Surgery, University of Arizona, Tucson, AZ, United States of America
| | - Russell S Witte
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States of America
- Department of Medical Imaging, University of Arizona, Tucson, AZ, United States of America
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50
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Yu Y, Wang X, Wang Q, Wang Q. A review of computational modeling and deep brain stimulation: applications to Parkinson's disease. APPLIED MATHEMATICS AND MECHANICS 2020; 41:1747-1768. [PMID: 33223591 PMCID: PMC7672165 DOI: 10.1007/s10483-020-2689-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/12/2020] [Indexed: 05/11/2023]
Abstract
Biophysical computational models are complementary to experiments and theories, providing powerful tools for the study of neurological diseases. The focus of this review is the dynamic modeling and control strategies of Parkinson's disease (PD). In previous studies, the development of parkinsonian network dynamics modeling has made great progress. Modeling mainly focuses on the cortex-thalamus-basal ganglia (CTBG) circuit and its sub-circuits, which helps to explore the dynamic behavior of the parkinsonian network, such as synchronization. Deep brain stimulation (DBS) is an effective strategy for the treatment of PD. At present, many studies are based on the side effects of the DBS. However, the translation from modeling results to clinical disease mitigation therapy still faces huge challenges. Here, we introduce the progress of DBS improvement. Its specific purpose is to develop novel DBS treatment methods, optimize the treatment effect of DBS for each patient, and focus on the study in closed-loop DBS. Our goal is to review the inspiration and insights gained by combining the system theory with these computational models to analyze neurodynamics and optimize DBS treatment.
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Affiliation(s)
- Ying Yu
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
| | - Xiaomin Wang
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
| | - Qishao Wang
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
| | - Qingyun Wang
- Department of Dynamics and Control, Beihang University, Beijing, 100191 China
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