期刊
NEUROLOGY AND THERAPY
卷 9, 期 1, 页码 25-41出版社
SPRINGER LONDON LTD
DOI: 10.1007/s40120-020-00181-9
关键词
Contact; Deep brain stimulation; Directionality; Lead; Parkinson disease; Programming
资金
- NIH [KL2 TR001426, NCATS KL2 TR002539, NINDS K23 NS114178, R01 NS40902]
- Lundbeck
- AbbVie
- Lusofarmaco
- Chiesi Farmaceutici
- Medtronic
- UCB Pharma
- Boston Scientific
- Abbott
- Cummings Foundation
- Dystonia Medical Research Foundation Canada
- Michael J. Fox Foundation
- University of Toronto
- Neuroderm
- Biogen Inc
- Prilenia therapeutics
Several single-center studies and one large multicenter clinical trial demonstrated that directional deep brain stimulation (DBS) could optimize the volume of tissue activated (VTA) based on the individual placement of the lead in relation to the target. The ability to generate axially asymmetric fields of stimulation translates into a broader therapeutic window (TW) compared to conventional DBS. However, changing the shape and surface of stimulating electrodes (directional segmented vs. conventional ring-shaped) also demands a revision of the programming strategies employed for DBS programming. Model-based approaches have been used to predict the shape of the VTA, which can be visualized on standardized neuroimaging atlases or individual magnetic resonance imaging. While potentially useful for optimizing clinical care, these systems remain limited by factors such as patient-specific anatomical variability, postsurgical lead migrations, and inability to account for individual contact impedances and orientation of the systems of fibers surrounding the electrode. Alternative programming tools based on the functional assessment of stimulation-induced clinical benefits and side effects allow one to collect and analyze data from each electrode of the DBS system and provide an action plan of ranked alternatives for therapeutic settings based on the selection of optimal directional contacts. Overall, an increasing amount of data supports the use of directional DBS. It is conceivable that the use of directionality may reduce the need for complex programming paradigms such as bipolar configurations, frequency or pulse width modulation, or interleaving. At a minimum, stimulation through directional electrodes can be considered as another tool to improve the benefit/side effect ratio. At a maximum, directionality may become the preferred way to program because of its larger TW and lower energy consumption.
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