Determining position suitability for implantation of deep brain stimulation leads

When treating patients using deep brain stimulation, precise positioning of deep brain stimulation (DBS) electrodes is crucial for optimising treatment and minimising the risk of undesirable, possibly unpleasant side effects. Unfortunately, currently available methods for positioning DBS leads are prone to error and can be inaccurate, compromising patients’ treatment and recovery.

Oxford University researchers have developed a method for assessing the suitability of a target for DBS and for assessing the suitability of the implanted position of a DBS lead. The method that uses electrophysiological signals obtained from multiple electrodes to determine the proximity of an implanted DBS lead to a target implantation position. This avoids the risk of adverse side effects caused by incorrect positioning and is less prone to error than current methods. It is also less time consuming and allows functional areas within a neurological structure to be distinguished. The method can also be used to check the location of implantation of a DBS lead.

Assessing the suitability of a target for deep brain stimulation

Oxford University researchers have developed a method for assessing the suitability of a target for deep brain stimulation (DBS) and for assessing the suitability of the implanted position of a DBS lead. The method can also be used to check the location of implantation of a DBS lead.

When treating patients using deep brain stimulation, precise positioning of DBS electrodes is crucial for optimising treatment and minimising the risk of undesirable, possibly unpleasant side effects. Unfortunately, currently available methods for positioning DBS leads are prone to error and can be inaccurate, compromising patients’ treatment and recovery.

Current methods

More than 80% of DBS therapy centres pick the target location for DBS using direct visualisation on MRI or CT images, informed by typical stereotactic co-ordinates from anatomical atlases. It is extremely difficult, just from CT or MRI images alone, to distinguish functional areas within a neurological structure. For example, during some DBS treatment of Parkinson’s disease, a particular region of the subthalamic nucleus (STN) should be targeted. However, stimulation is often incorrectly applied through a contact in part of the STN sub-serving limbic function – a region that is indistinguishable from the motor areas of the STN on routine clinical scans.

The current solution uses a plurality of micro-electrodes in the determination phase to “scope-out” what the best trajectory might be for the DBS lead, and then a thicker DBS probe can be inserted for actually providing DBS. Better results can be achieved compared with MRI or CT scanning alone, however inserting multiple leads into brain increases the risk of bleeding and insertion into an area where insertion/ stimulation is not required. This method is also time-consuming and prone to error.

The stereotactic frames used in surgery can also cause errors if they develop a fault, such as a slight twist or wear and tear. This can lead to stimulation of other parts of the brain and corresponding unpleasant side effects.

A stimulating solution

The Oxford method uses electrophysiological signals obtained from multiple electrodes to determine the proximity of an implanted DBS lead to a target implantation position. This avoids the risk of adverse side effects caused by incorrect positioning and is less prone to error than current methods. It is also less time consuming and allows functional areas within a neurological structure to be distinguished.

Oxford University Innovation has filed a patent application and is looking to speak with companies interested in licensing this technology.

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