Objective: The aim of this study is to summarize potential stimulation and sensing advantages of high resolution DBS leads.

Background: Deep brain stimulation (DBS) is an effective treatment for movement disorders including Parkinson’s disease (PD). Leads containing electrodes deliver electrical stimulation to appropriate targets in the brain. Clinical outcomes rely on precise delivery of electric fields, where diffusion of electric fields to undesired tissue can result in side effects. In addition to providing stimulation capabilities, electrodes may be used to record local field potential (LFP) activity to inform contact selection or lead placement. Commercially available leads typically have 4 electrodes along the lead, with recent interest increasing for the use of higher resolution lead designs.

Methods: Computer models were used to generate examples to illustrate the effects of electrode geometry on the volume of neural activation (VNA). Activation patterns of a 40-contact high resolution DBS lead were compared to those of a conventional DBS lead, Medtronic model 3389. Data and examples from the literature and this modeling study are used to summarize the potential advantages of directional stimulation and sensing capabilities.

Results: High resolution directional lead designs may provide advantages from a stimulation perspective relative to conventional leads: (1) asymmetrical field steering that enable VNAs to be centered off the lead axis and steered away from areas eliciting side effects; (2) increased resolution for shifting the VNA position along the lead axis; (3) increased flexibility for shaping the VNA by the use of multiple active electrode contacts. High resolution leads may also provide advantages from a sensing perspective. Results from the literature indicate that the spatial extent of beta LFP activity in the subthalamic nucleus can range from <1 to 4 mm and can be distributed directionally around the electrode. This suggests that directional leads with electrode spacing in this range may be useful to target a spatially distributed source.

Conclusions: High resolution leads have the potential to improve DBS therapy by enabling off-axis field steering, increasing field shaping capabilities, and increasing resolution of field positioning along the lead. Simultaneous LFP recording at different depths and directions may potentially inform stimulation setting selection.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/potential-advantages-of-high-resolution-lead-designs-for-deep-brain-stimulation/