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.
Highlights
Clinical studies investigating Deep Brain Stimulation (DBS) have provided evidence of its effectiveness in the treatment of motor symptoms in movement disorders such as Parkinson’s Disease (PD) and Dystonia [1]
Pulses are generated by an Implantable Pulse Generator (IPG) connected through implanted electrical wires to an array of electrodes targeted to be placed adjacent to specific brain structures
Volume of Tissue Activated (VTA) were generated for different target radii and for different pulse amplitude distributions (Table 1) for Multiple Independent Current Control (MICC) and
Summary
Clinical studies investigating Deep Brain Stimulation (DBS) have provided evidence of its effectiveness in the treatment of motor symptoms in movement disorders such as Parkinson’s Disease (PD) and Dystonia [1]. Pulses are generated by an Implantable Pulse Generator (IPG) connected through implanted electrical wires to an array of electrodes targeted to be placed adjacent to specific brain structures. The accuracy to steer stimulation fields, which depends on the electronic architecture of the IPG, play an important role in directional DBS. 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.
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