Abstract
Objective. We performed a retrospective analysis of an optimization algorithm for the computation of patient-specific multipolar stimulation configurations employing multiple independent current/voltage sources. We evaluated whether the obtained stimulation configurations align with clinical data and whether the optimized stimulation configurations have the potential to lead to an equal or better stimulation of the target region as manual programming, while reducing the time required for programming sessions. Approach. For three patients (five electrodes) diagnosed with essential tremor, we derived optimized multipolar stimulation configurations using an approach that is suitable for the application in clinical practice. To evaluate the automatically derived stimulation settings, we compared them to the results of the monopolar review. Main results. We observe a good agreement between the findings of the monopolar review and the optimized stimulation configurations, with the algorithm assigning the maximal voltage in the optimized multipolar pattern to the contact that was found to lead to the best therapeutic effect in the clinical monopolar review in all cases. Additionally, our simulation results predict that the optimized stimulation settings lead to the activation of an equal or larger volume fraction of the target compared to the manually determined settings in all cases. Significance. Our results demonstrate the feasibility of an automatic determination of optimal DBS configurations and motivate a further evaluation of the applied optimization algorithm.
Highlights
Deep brain stimulation (DBS) has been established as a treatment for movement disorders, such as Parkinson’s disease and essential tremor [24, 66], and is currently being evaluated as a treatment for a variety of other neurological disorders
We performed a retrospective evaluation of an algorithm for the automated optimization of DBS configurations that utilize independent current/voltage sources for each contact, as they are available in novel implanted pulse generators (IPG) [1, 58]
The computed stimulation configurations are in good agreement with the results of the monopolar review; in all cases, the optimization algorithm assigned the strongest stimulation voltage to the contact that was clinically selected, and the predicted target activation achieved by the optimization algorithm was at least equal to the clinically determined settings; in four of five cases, the predicted target activation was improved
Summary
Deep brain stimulation (DBS) has been established as a treatment for movement disorders, such as Parkinson’s disease and essential tremor [24, 66], and is currently being evaluated as a treatment for a variety of other neurological disorders. The time expended for the manual programming of DBS patients is expected to grow exponentially with the emerging use of DBS leads that have an increased number of contacts than the previously standard quadripolar leads in combination with implanted pulse generators (IPG) that offer multiple independent current sources. Such stimulation setups are promising better treatment outcomes due to their improved field-shaping abilities [11, 61, 17, 48, 60, 67]
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