Current steering to control the volume of tissue activated during deep brain stimulation

Background Over the last two decades, deep brain stimulation (DBS) has become a recognized and effective clinical therapy for numerous neurologic conditions. Since its inception, clinical DBS technology has progressed at a relatively slow rate; however, numerous advances in neural engineering research have the potential to improve DBS systems. One such advance is the concept of current steering, or the use of multiple stimulation Sources to direct current flow through targeted regions of brain tissue. The goals of this study were to develop a theoretical understanding of the effects of current steering in the context of DBS, and use that information to evaluate the potential use of current steering during stimulation of the subthalamic nucleus. Methods We used finite element electric field models, coupled to multicompartment cable axon models, to predict the volume of tissue activated (VTA) by DBS as a function of the stimulation parameter settings. Results Balancing current flow through adjacent cathodes can increase the VTA magnitude, relative to monopolar stimulation, and current steering can be an effective technique to sculpt the shape of the VTA to fit a given anatomic tat-get. Conclusions These results provide motivation for the integration of current steering technology into clinical DBS systems, thereby expanding opportunities to customize DBS to individual patients, and potentially enhancing therapeutic efficacy. (C) 2008 Elsevier Inc. All rights reserved.