Characterization of the stimulus waveforms generated by implantable pulse generators for deep brain stimulation

Objective: To determine the circuit elements required to theoretically describe the stimulus waveforms generated by an implantable pulse generator (IPG) during clinical deep brain stimulation (DBS). Methods: We experimentally interrogated the Medtronic Activa PC DBS IPG and defined an equivalent circuit model that accurately captured the output of the IPG. We then compared the detailed circuit model of the clinical stimulus waveforms to simplified representations commonly used in computational models of DBS. We quantified the errors associated with these simplifications using theoretical activation thresholds of myelinated axons in response to DBS. Results: We found that the detailed IPG model generated substantial differences in activation thresholds compared to simplified models. These differences were largest for bipolar stimulation with long pulse widths. Average errors were similar to 3 to 24% for voltage-controlled stimulation and similar to 2 to 11% for current-controlled stimulation. Conclusions: Our results demonstrate the importance of including basic circuit elements (e.g. blocking capacitors, lead wire resistance, electrode capacitance) in model analysis of DBS. Significance: Computational models of DBS are now commonly used in academic research, industrial technology development, and in the selection of clinical stimulation parameters. Incorporating a realistic representation of the IPG output is necessary to improve the accuracy and utility of these clinical and scientific tools. (C) 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.