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Potentials and Limitations of Directional Deep Brain Stimulation: A Simulation Approach
Johanna Kramme1, Till A Dembek2, Harald Treuer3
1Department of Stereotactic and Functional Neurosurgery, University of Cologne Faculty of Medicine and University Hospital Cologne, Cologne, Germany, johanna.kramme@uk-koeln.de.
Stereotactic and Functional Neurosurgery
|October 20, 2020
Summary
Directional leads in deep brain stimulation can compensate for minor lead misplacements up to 1 mm. Optimized programming using directional steering improves VTA overlap, potentially reducing side effects and enhancing clinical benefits.
Area of Science:
- Neurosurgery
- Biomedical Engineering
- Computational Neuroscience
Background:
- Directional leads enhance deep brain stimulation (DBS) by enabling electrical field shaping in the axial plane.
- This capability introduces programming complexity, necessitating optimized approaches for clinical application.
- Maximizing the clinical benefit of DBS with directional leads requires advanced programming strategies.
Purpose of the Study:
- To investigate the efficacy of directional steering in compensating for lead malposition.
- To determine the extent to which electrical field shaping can mitigate the effects of misplaced DBS leads.
- To evaluate the impact of lead malposition on VTA and identify optimal compensation strategies.
Main Methods:
- Simulated binary volumes of tissue activated (VTA) using a finite element method.
- Applied different amplitude distributions across three directional electrodes.
- Shifted VTAs to assess compensation for lead malpositions at various angles and distances.
Main Results:
- Directional leads effectively compensate for malpositions up to 1 mm, maximizing VTA overlap.
- Improvements in overlap range from 10-30% for larger shifts, contingent on stimulation amplitude and angle.
- Lead orientation and shift significantly influence electrode amplitude distribution.
Conclusions:
- Accurate amplitude distribution for directional leads requires knowledge of both shift angle and shift to target volume.
- While current directional leads have limitations for malpositions >1 mm, they surpass conventional leads in reducing overstimulation and side effects.
- Future optimized lead programming algorithms can leverage simulation databases for enhanced DBS therapy.
