Multiple source current steering - a novel deep brain stimulation concept forcustomized programming in a Parkinson's disease patient

摘要

This case report is in accordance with the Declaration of Helsinki. Deep brain stimulation was carried out with the adequate understanding and written consent of the patient involved and with the ethical approval of the authors' institutional review board. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a safe and effective treatment for Parkinson's disease (PD). However, small variations in stimulation current can cause excessive neural activation of neighboring anatomical structures or the non-motor portions of the STN which might induce unintended side effects. Therefore, in a number of patients, this leads to the dilemma of choosing suboptimal stimulation parameters to avoid side effects at the cost of suboptimal suppression of motor symptoms. In conventional, single-source DBS systems (voltage- and current-control systems), precision and stability of therapy delivery may be limited since each contact cannot be controlled independently. In contrast, simulation models of DBS indicate that current steering with multiple stimulation sources might be able to transfer current more precisely and more constant over time [1,2]. In principle this approach might be a helpful tool for the clinician to control side effects thereby improving the overall outcome of DBS.