Clinical outcome of deep brain stimulation for dystonia: constant‐current or constant‐voltage stimulation? A non‐randomized study

Lettieri, Christian; Rinaldo, Sara; Devigili, Grazia; Pisa, Federica Edith; Mucchiut, M.; Belgrado, Enrico; Mondani, Massimo; D’Auria, Stanislao; Ius, Tamara; Škrap, Miran; Eleopra, Roberto

doi:10.1111/ene.12515

Cited by 44 publications

(40 citation statements)

References 32 publications

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“…Present literature seems to show that current controlled stimulation induces at least as good clinical effects as voltage controlled stimulation [6,7], and that it should be preferred towards voltage controlled devices due to the automatic voltage adjustment as impedance changes [8,9]. Nevertheless, to switch from one mode to the other remains complicated as clinicians risk to lose their reference for programming.…”

Section: Introductionmentioning

confidence: 99%

Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes ? A Simulation Study

Alonso¹,

Hemm-Ode²,

Wårdell³

2015

Brain Disord Ther

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Background: Deep brain stimulation (DBS) systems in current mode and new lead designs are recently available. To switch between DBS-systems remains complicated as clinicians may lose their reference for programming. Simulations can help increase the understanding.Objective: To quantitatively investigate the electric field (EF) around two lead designs simulated to operate in voltage and current mode under two time points following implantation. Methods:The finite element method was used to model Lead 3389 (Medtronic) and 6148 (St Jude) with homogenous surrounding grey matter and a peri-electrode space (PES) of 250 µm. The PES-impedance mimicked the acute (extracellular fluid) and chronic (fibrous tissue) time-point. Simulations at different amplitudes of voltage and current (n=236) were performed using two different contacts. Equivalent current amplitudes were extracted by matching the shape and maximum EF of the 0.2 V/mm isolevel. Results:The maximum EF extension at 0.2 V/mm varied between 2-5 mm with a small difference between the leads. In voltage mode EF increased about 1 mm at acute compared to the chronic PES. Current mode presented the opposite relationship. Equivalent EFs for lead 3389 at 3 V were found for 7 mA (acute) and 2.2 mA (chronic). Conclusions:Simulations showed a major impact on the electric field extension between postoperative time points. This may explain the clinical decisions to reprogram the amplitude weeks after implantation. Neither the EF extension nor intensity is considerably influenced by the lead design. However, the EF distribution is affected by the larger contact of Lead 6148 generating an electric field below the tip.

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Section: Introductionmentioning

confidence: 99%

Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes ? A Simulation Study

Alonso¹,

Hemm-Ode²,

Wårdell³

2015

Brain Disord Ther

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“…A currentcontrolled stimulation is applied, which is gaining increased interest in clinical application due to the reduced side effects and sensitivity to inter-individual variabilities [22], [23]. Different values for the dielectric properties of the volume conductor model compartments are employed to investigate the approximation quality for different cases of tissue heterogeneity in the target area.…”

Section: H Approximating the Neural Activation By Field Thresholdsmentioning

confidence: 99%

Adaptive Estimation of the Neural Activation Extent in Computational Volume Conductor Models of Deep Brain Stimulation

Schmidt

Rienen

2018

IEEE Trans. Biomed. Eng.

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Abstract-Objective: The aim of this study is to propose an adaptive scheme embedded into an open-source environment for the estimation of the neural activation extent during deep brain stimulation and to investigate the feasibility of approximating the neural activation extent by thresholds of the field solution. Methods: Open-source solutions for solving the field equation in volume conductor models of deep brain stimulation and computing the neural activation are embedded into a Python package to estimate the neural activation dependent on the dielectric tissue properties and axon parameters by employing a spatially adaptive scheme. Feasibility of the approximation of the neural activation extent by field thresholds is investigated to further reduce the computational expense. Results: The varying extents of neural activation for different patient-specific dielectric properties were estimated with the adaptive scheme. The results revealed the strong influence of the dielectric properties of the encapsulation layer in the acute and chronic phase after surgery. The computational time required to determine the neural activation extent in each studied model case was substantially reduced. Conclusion: The neural activation extent is altered by patientspecific parameters. Threshold values of the electric potential and electric field norm facilitate a computationally efficient method to estimate the neural activation extent. Significance: The presented adaptive scheme is able to robustly determine neural activation extents and field threshold estimates for varying dielectric tissue properties and axon diameters while reducing substantially the computational expense. , from which electrical stimulation of the sensorimotor zone is mostly associated with the relief of motor symptoms of PD [4]. Due to patient-specific parameters, such as brain structure anatomy, dielectric tissue properties, electrode location, and severity of symptoms, the adjustment and optimization of stimulation parameters during and after surgery can be rather time consuming and connected Manuscript submitted to IEEE TBME on April, 26 2017. Asterisk indicates corresponding author.* C. Schmidt is with the Institute of General Electrical Engineering, University of Rostock, 18059 Rostock, Germany (e-mail: cschmidt18057@gmail.com) U. van Rienen is with the Institute of General Electrical Engineering, University of Rostock, 18059 Rostock, Germany to additional costs. Computational models provide a possibility to estimate the stimulation impact by determining activated areas in the deep brain based on the given patient-specific parameters. The extent of neural activation, or the volume of tissue activated (VTA), is a common computational modeling approach to estimate the size of the activated tissue during DBS and has been applied in various computational studies in this area including homogeneous [5], rotationally symmetric [6], heterogeneous [7], [8], and anisotropic volume conductor models [9] of the human brain and deep brain target areas. In general, ...

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“…For DBS, a range of frequencies, pulse widths, and amplitude values as well as the differences between constant-current and constant-voltage have been reported [70, 71]. The location of the implanted electrodes and the disorder being treated play a large role in determining the best stimulation parameters for successful treatment [70, 71].…”

Section: Clinical Application Of Electrical Stimulation For Therapmentioning

confidence: 99%

“…The location of the implanted electrodes and the disorder being treated play a large role in determining the best stimulation parameters for successful treatment [70, 71]. It is proposed that DBS mimics a lesion thereby leading to inhibition of local neuronal networks, disruption of abnormal firing in the brain, and/or it could also involve stimulation-induced release of neurotransmitters locally and through larger networks as reviewed by Chiken et al and Herrington et al [72, 73].…”

Section: Clinical Application Of Electrical Stimulation For Therapmentioning

confidence: 99%

Environmental Factors That Influence Stem Cell Migration: An “Electric Field”

Iwasa

Babona-Pilipos

Morshead

2017

Stem Cells International

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Environmental Stimulus of Electric Fields on Stem Cell Migration. The movement of cells in response to electric potential gradients is called galvanotaxis. In vivo galvanotaxis, powered by endogenous electric fields (EFs), plays a critical role during development and wound healing. This review aims to provide a perspective on how stem cells transduce EFs into directed migration and an understanding of the current literature relating to the mechanisms by which cells sense and transduce EFs. We will comment on potential EF-based regenerative medicine therapeutics.

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Clinical outcome of deep brain stimulation for dystonia: constant‐current or constant‐voltage stimulation? A non‐randomized study

Abstract: Current-controlled stimulation is effective during GPi-DBS for primary dystonia and it could be a better choice than voltage-controlled stimulation over long-term follow-up.

Cited by 44 publications

References 32 publications

Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes ? A Simulation Study

Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes ? A Simulation Study

Adaptive Estimation of the Neural Activation Extent in Computational Volume Conductor Models of Deep Brain Stimulation

Environmental Factors That Influence Stem Cell Migration: An “Electric Field”

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