Model-Based Analysis of Pathway Recruitment During Subthalamic Deep Brain Stimulation

Kelsey L Bower; Angela M Noecker; Anneke M Frankemolle-Gilbert; Cameron C McIntyre

doi:10.1016/j.neurom.2023.02.084

Model-Based Analysis of Pathway Recruitment During Subthalamic Deep Brain Stimulation

Neuromodulation. 2024 Apr;27(3):455-463. doi: 10.1016/j.neurom.2023.02.084. Epub 2023 Apr 25.

Authors

Kelsey L Bower¹, Angela M Noecker², Anneke M Frankemolle-Gilbert³, Cameron C McIntyre⁴

Affiliations

¹ Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
² Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
³ Department of Biomedical Engineering, Duke University, Durham, NC, USA.
⁴ Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA. Electronic address: cameron.mcintyre@duke.edu.

PMID: 37097269
PMCID: PMC10598236 (available on 2025-04-01)
DOI: 10.1016/j.neurom.2023.02.084

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: Axons; Parkinson’s disease; electrode; subthalamic nucleus.

MeSH terms

Axons
Deep Brain Stimulation*
Electrodes
Humans
Parkinson Disease* / therapy
Subthalamic Nucleus* / physiology

Abstract

MeSH terms

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