Abstract
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.
Highlights
Deep brain stimulation (DBS) is an established therapy for movement disorders such as Parkinson’s disease (PD), essential tremor and dystonia [1]
Simulations showed a major impact on the electric field extension between postoperative time points
The shape and maximal extension of the electric field (EF) considerably differed between the two simulated time points for all contacts
Summary
Deep brain stimulation (DBS) is an established therapy for movement disorders such as Parkinson’s disease (PD), essential tremor and dystonia [1]. To date more than 120,000 patients have received DBS implants. During the first two decades of the modern DBS era all implantations were performed using the same type of stimulation control and lead configuration; a four contact lead connected to a voltage controlled neurostimulator. In 2009 the first current controlled DBS device was introduced in Europe on PD patients. Today several DBS lead designs and stimulation modes are available but still not fully established as clinical alternatives. Intensive research is being performed to develop new DBS systems, e.g. for steering of the simulation field [2,3,4,5]. Deep brain stimulation (DBS) systems in current mode and new lead designs are recently available.
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