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Published on: August 12, 2018
Directional steering: A novel approach to deep brain stimulation
M Fiorella Contarino1, Lo J Bour2, Rens Verhagen2
1From the Departments of Neurology/Clinical Neurophysiology (M.F.C., L.J.B., R.V., M.A.J.L., R.M.A.d.B.) and Neurosurgery (P.v.d.M., P.R.S.), Academic Medical Center, University of Amsterdam, the Netherlands; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands. p.r.schuurman@amc.nl m.f.contarino@amc.uva.nl.
Objective:
The aim of this study was to investigate whether directional steering through a novel 32-contact electrode is safe and can modulate the thresholds for beneficial and side effects of stimulation.
Methods:
The study is a single-center, performance and safety study. Double-blind intraoperative evaluations of the thresholds for therapeutic benefit and for side effects were performed in 8 patients with Parkinson disease while stimulating in randomized order in spherical mode and in 4 different steering modes with the 32-contact electrode, and in monopolar mode with a commercial electrode. In addition, simultaneous recordings of local field potentials through all 32 contacts were performed.
Results:
There were no adverse events related to the experimental device. For 13 of 15 side effects (87%), the threshold could be increased by ≥ 1 mA while steering in at least one direction in comparison to conventional spherical stimulation, thereby increasing the therapeutic window by up to 1.5 mA. Recording local field potentials through all 32 electrode contacts yielded spatiotemporal information on pathologic neuronal activity.
Conclusions:
Controlled steering of current through the brain may improve the effectiveness of deep brain stimulation (DBS), allow for novel applications, and provide a tool to better explore pathophysiologic activity in the brain.
Classification Of Evidence:
This study provides Class IV evidence that for patients with Parkinson disease, steering DBS current is well tolerated, increases the threshold for side effects, and may improve the therapeutic window of subthalamic nucleus DBS as compared with current standard spherical stimulation.
Insights
This study shows that directional steering of deep brain stimulation (DBS) current is safe for Parkinson
Area of Science:
- Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- Deep brain stimulation (DBS) is a key treatment for Parkinson disease.
- Current DBS systems use spherical stimulation, which may not precisely target therapeutic areas or avoid side effects.
Purpose of the Study:
- To evaluate the safety and efficacy of directional current steering using a novel 32-contact electrode in Parkinson disease patients.
- To determine if directional steering can modulate stimulation thresholds for therapeutic benefits and side effects.
Main Methods:
- A single-center, double-blind safety and performance study was conducted.
- Eight Parkinson disease patients underwent intraoperative evaluation of stimulation thresholds in spherical and various steering modes.
- Simultaneous local field potential recordings were made using all 32 electrode contacts.
Main Results:
- No adverse events were associated with the experimental device.
- Directional steering increased the threshold for 87% of side effects compared to spherical stimulation, widening the therapeutic window by up to 1.5 mA.
- Local field potential recordings provided spatiotemporal insights into neuronal activity.
Conclusions:
- Controlled current steering via DBS is safe and well-tolerated in Parkinson disease patients.
- Directional steering improves the therapeutic window and may enhance DBS effectiveness.
- This technology offers potential for novel applications and better exploration of brain pathophysiology.
