Abstract
Background
Subthalamic deep brain stimulation (DBS) is an established clinical therapy, but an
anatomically clear definition of the underlying neural target(s) of the stimulation
remains elusive. Patient-specific models of DBS are commonly used tools in the search
for stimulation targets, and recent iterations of those models are focused on characterizing
the brain connections that are activated by DBS.
Objective
The goal of this study was to quantify axonal pathway activation in the subthalamic
region from DBS at different electrode locations and stimulation settings.
Materials and Methods
We used an anatomically and electrically detailed computational model of subthalamic
DBS to generate recruitment curves for eight different axonal pathways of interest,
at three generalized DBS electrode locations in the subthalamic nucleus (STN) (ie,
central STN, dorsal STN, posterior STN). These simulations were performed with three
levels of DBS electrode localization uncertainty (ie, 0.5 mm, 1.0 mm, 1.5 mm).
Results
The recruitment curves highlight the diversity of pathways that are theoretically
activated with subthalamic DBS, in addition to the dependence of the stimulation location
and parameter settings on the pathway activation estimates. The three generalized
DBS locations exhibited distinct pathway recruitment curve profiles, suggesting that
each stimulation location would have a different effect on network activity patterns.
We also found that the use of anodic stimuli could help limit activation of the internal
capsule relative to other pathways. However, incorporating realistic levels of DBS
electrode localization uncertainty in the models substantially limits their predictive
capabilities.
Conclusions
Subtle differences in stimulation location and/or parameter settings can impact the
collection of pathways that are activated during subthalamic DBS.
Keywords
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Comments
Article info
Publication history
Published online: April 25, 2023
Accepted:
February 27,
2023
Received in revised form:
February 6,
2023
Received:
December 22,
2021
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: This work was supported by grants from the National Institutes of Health (R01 NS105690; F31 NS098696).
Conflict of Interest: Cameron C. McIntyre is a paid consultant for Boston Scientific Neuromodulation, receives royalties from Hologram Consultants, Neuros Medical, and Qr8 Health, and is a shareholder in the following companies: Hologram Consultants, Surgical Information Sciences, BrainDynamics, CereGate, Autonomic Technologies, Cardionomic, and Enspire DBS. Angela M. Noecker is a paid consultant for Hologram Consultants. Kelsey L. Bower is an employee for CereGate and completed an internship with Boston Scientific. Anneke M. Frankemolle-Gilbert reported no conflict of interest.
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© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
