title: A novel lead design enables selective deep brain stimulation of neural populations in the subthalamic region.
abstract: OBJECTIVE
  The clinical effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) as a treatment for Parkinson's disease are sensitive to the location of the DBS lead within the STN. New high density (HD) lead designs have been created which are hypothesized to provide additional degrees of freedom in shaping the stimulating electric field. The objective of this study is to compare the performances of a new HD lead with a conventional cylindrical contact (CC) lead.
  
  
  METHODS
  A computational model, consisting of a finite element electric field model combined with multi-compartment neuron and axon models representing different neural populations in the subthalamic region, was used to evaluate the two leads. We compared ring-mode and steering-mode stimulation with the HD lead to single contact stimulation with the CC lead. These stimulation modes were tested for the lead: (1) positioned in the centroid of the STN, (2) shifted 1 mm towards the internal capsule (IC), and (3) shifted 2 mm towards the IC. Under these conditions, we quantified the number of STN neurons that were activated without activating IC fibers, which are known to cause side-effects.
  
  
  RESULTS
  The modeling results show that the HD lead is able to mimic the stimulation effect of the CC lead. Additionally, in steering-mode stimulation there was a significant increase of activated STN neurons compared to the CC mode.
  
  
  CONCLUSIONS
  From the model simulations we conclude that the HD lead in steering-mode with optimized stimulation parameter selection can stimulate more STN cells. Next, the clinical impact of the increased number of activated STN cells should be tested and balanced across the increased complexity of identifying the optimized stimulation parameter settings for the HD lead.
authors.affiliation: MIRA institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, NL, The Netherlands.
authors.forename: Kees J
authors.initials: KJ
authors.lastname: van Dijk
authors.forename: Rens
authors.initials: R
authors.lastname: Verhagen
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Chaturvedi
authors.forename: Cameron C
authors.initials: CC
authors.lastname: McIntyre
authors.forename: Lo J
authors.initials: LJ
authors.lastname: Bour
authors.forename: Ciska
authors.initials: C
authors.lastname: Heida
authors.forename: Peter H
authors.initials: PH
authors.lastname: Veltink
mesh_terms: D000200:Action Potentials / Q000502:physiology; D003198:Computer Simulation; D017076:Computer-Aided Design; D046690:Deep Brain Stimulation / Q000295:instrumentation*; D004553:Electric Conductivity; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D008959:Models, Neurological; D009415:Nerve Net / Q000502:physiology*; D009474:Neurons / Q000502:physiology*; D020531:Subthalamic Nucleus / Q000502:physiology*