PhD

Models and Simulations of the Electric Field in Deep Brain Stimulation

Deep brain stimulation (DBS) is an established surgical therapy for movement disorders such as Parkinson’s disease (PD) and essential tremor (ET). A thin electrode is implanted in a predefined area of the brain with the use of stereotactic neurosurgery. In the last few years new DBS electrodes and systems have been developed with possibilities for using more parameters for control of the stimulation volume.

In this thesis, simulations using the finite element method (FEM) have been developed and used for investigation of the electric field (EF) extension around different types of DBS lead designs (symmetric, steering) and stimulation modes (voltage, current). The electrode surrounding was represented either with a homogeneous model or a patient-specific model based on individual preoperative magnetic resonance imaging (MRI). The EF was visualized and compared for different lead designs and operating modes.

In Paper I, the EF was quantitatively investigated around two lead designs (3389 and 6148) simulated to operate in voltage and current mode under acute and chronic time points following implantation.Simulations showed a major impact on the EF extension between postoperative time points which may explain the clinical decisions to change the stimulation amplitude weeks after implantation.

In Paper II, the simulations were expanded to include two leads having steering function (6180, Surestim1) and patient-specific FEM simulations in the zona incerta. It was found that both the heterogeneity of the tissue and the operating mode, influence the EF distribution and that equivalent contact configurations of the leads result in similar EF. The steering mode presented larger volumes in current mode when using equivalent amplitudes. Simulations comparing DBS and intraoperative stimulation test using a microelectrode recording (MER) system (Paper III), showed that several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution and that the DBS EF volume can cover, but also extend to, other anatomical areas.

Paper IV introduces a method for an objective exploitation of intraoperative stimulation test data in order to identify the optimal implant position in the thalamus of the chronic DBS lead. Patient-specific EF simulations were related to the anatomy with the help of brain atlases and the clinical effects which were quantified by accelerometers. The first results indicate that the good clinical effect in ET is due to several structures around the ventral intermediate nucleus of the thalamus.

Bibliography

Publications

2018

Alonso F., Vogel D., Johansson J., Wårdell K., Hemm S. (2018) Electric field comparison between microelectrode recording and deep brainstimulation systems - A simulation study. Brain sciences 8(2), 28

2016

Alonso F., Latorre M., Göransson N., Zsigmond P., Wårdell K. (2016) Investigation into deep brain stimulation lead designs: a patient specific simulation study. Brain sciences 6(3), 39

Hemm S.Lien vers l'article
Hemm S. et al., Frontiers in Human Neuroscience 2016
Article
, Pison D., Alonso F., Shah A., Coste J., Lemaire JJ., Wårdell K. (2016) Patient-specific electric field simulations and acceleration measurements for objective analysis of intraoperative stimulation tests in the thalamus. Frontiers in Human Neuroscience 10, 577

2015

Alonso F., Hemm-Ode S., Wårdell K. (2015) Influence on deep brain stimulation from lead design, operating mode and tissue impedance changes - A simulation study. Brain Disorders and Therapy 4(3), 1000169

Communications

2018

Vogel D., Shah A., Alonso F., Lemaire J.-J., Coste J., Wårdell K., Hemm S. (26-29 Septembre 2018) Co-registering Thalamus for Analysis of Patient-specific Intra-operative Improvement Maps in DBS (Communication affichée) - 23th Congress of the European Society for Stereotactic and Functional Neurosurgery (Edimbourg, Ecosse)
Actes publiés (résumé P094Lien vers le résumé
Stereotactic and Functional Neurosurgery
Facteur d'impact 2018: 1.905
Résumé
) Stereotactic and Functional Neurosurgery 96 [Suppl. 1],

Shah A., Alonso F., Vogel D., Wardell K., Coste J., Lemaire J.-J., Pison D., Hemm S. (17-21 Juillet 2018) Analysis of adverse effects of stimulation during DBS surgery by patient-specific FEM simulations (Communication orale et affichée Lien vers la communication
Communication
) - 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (Honolulu, Hawaï)
Actes publiés (résumé ThuPoS14.15Lien vers le résumé
2018 40th Annual International Conference of the IEEE EMBC
Résumé
) 2018 40th Annual International Conference of the IEEE EMBC , 2222-2225

2017

Shah A., Alonso F., Lemaire J.-J., Pison D., Coste J., Wårdell K., Schkommodau E., Hemm S. (26-29 Juin 2017) Learning more about the optimal anatomical position for deep brain stimulation in essential tremor patients: 3d visualisation of intraoperative stimulation test results (Communication affichée) - 17th Quadrennial Meeting of the World Society for Stereotactic and Functional Neurosurgery (Berlin, Allemagne)
Actes publiés (résumé P013Lien vers le résumé
Stereotactic and Functional Neurosurgery
Facteur d'impact 2017: 1.648
Résumé
) Stereotactic and Functional Neurosurgery 95[Suppl. 1], 186

Shah A., Alonso F., Lemaire J.-J., Pison D., Coste J., Wårdell K., Schkommodau E., Hemm S. (12-15 Juin 2017) 3D visualization of intraoperative stimulation test results in deep brain stimulation (Communication affichée Lien vers la communication
Communication
) - Joint conference of the European Medical and Biological Engineering Conference and the Nordic-Baltic Conference on Biomedical Engineering and Medical Physics (Tampere, Finlande)

2016

Shah A., Alonso F., Pison D., Lemaire J.-J., Wårdell K., Coste J., Schkommodau E., Hemm-Ode S. (4-6 Octobre 2016) 3D Visualization of intraoperative stimulation test results for better target selection in DBS surgery (Communication affichée) - Meeting of the Swiss, Austrian and German Societies of Biomedical Engineering (Bâle, Suisse)
Actes publiés (résumé UPP04Lien vers le résumé
Biomedizinische Technik. Biomedical engineering
Facteur d'impact 2016: 0.915
Résumé
) Biomedizinische Technik. Biomedical engineering 61[Suppl 1-U], S243

Shah A., Alonso F., Lemaire J.-J., Wårdell K., Pison D., Coste J., Schkommodau E., Hemm-Ode S. (28-30 Septembre 2016) Improving DBS targeting using 3D visualization of intraoperative stimulation tests (Communication affichée Lien vers la communication
Communication
) - 22th Congress of the European Society for Stereotactic and Functional Neurosurgery (Madrid, Espagne)
Actes publiés (résumé 8605Lien vers le résumé
Stereotactic and Functional Neurosurgery
Facteur d'impact 2016: 1.692
Résumé
) Stereotactic and Functional Neurosurgery 94[Suppl. 1], 101

2015

Pison D., Alonso F., Wårdell K., Shah A., Coste J., Lemaire J.-J., Schkommodau E., Hemm-Ode S. (7-12 Juin 2015) A method for side effect analysis based on electric field simulations for intraoperative test stimulation in deep brain stimulation surgery (Communication orale) - IUPESM World Congress on Medical Physics and Biomedical Engineering (Toronto, Canada)
Actes publiés (résumé SP121.2Lien vers le résumé
Abstracts IUPESM 2015 World Congress on Medical Physics & Biomedical Eng...
Résumé
) Abstracts IUPESM 2015 World Congress on Medical Physics & Biomedical Eng... , 348

Pison D., Alonso F., Wårdell K., Shah A., Coste J., Lemaire J.-J., Schkommodau E., Hemm-Ode S. (22-24 Avril 2015) A method for electric field simulations and acceleration measurements for intraoperative test stimulation (Communication affichée Lien vers la communication
Communication
) - 7th international IEEE EMBS Conference on Neural Engineering (Montpellier)
Actes publiés (résumé 485Lien vers le résumé
Neural Engineering (NER), 2015 7th International IEEE/EMBS Conference on
Résumé
) Neural Engineering (NER), 2015 7th International IEEE/EMBS Conference on ,

2014

Hemm-Ode S., Pison D., Alonso F., Shah A., Coste J., Lemaire J.-J., Schkommodau E., Wårdell K. (17-20 Septembre 2014) A method for electric field simulations and acceleration measure-ments for intraoperative test stimulation (Communication affichée Lien vers la communication
Communication
) - 21th Congress of the European Society for Stereotactic and Functional Neurosurgery (Maastricht, Pays-Bas)
Actes publiés (résumé 91Lien vers le résumé
Stereotactic and Functional Neurosurgery
Facteur d'impact 2014: 2.019
Résumé
) Stereotactic and Functional Neurosurgery 92[Suppl 2], 153

Hemm-Ode S., Alonso F., Pison D., Shah A., Coste J., Lemaire J.-J., Wårdell K. (15-16 Mai 2014) Patient-specific electric field simulations and acceleration measurements for intraoperative test-stimulations (Communication orale) - 1st IMPACT Workshop and 7th NeuroTech Workshop (Linköping, Suède)



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