Laleh Golestanirad

Analysis of fractal electrodes for efficient neural stimulation

Planar electrodes are increasingly used in a variety of neural stimulation techniques such as epidural spinal cord stimulation, epidural cortical stimulation, transcranial direct current stimulation and functional electric stimulation. Recently, optimized electrode geometries have been shown to increase the efficiency of neural stimulation by maximizing the variation of current density on the electrode surface. In the present work, a new family of modified fractal electrode geometries is developed to increase the neural activation function and enhance the efficiency of neural stimulation. It is hypothesized that the key factor in increasing the activation function in the tissue adjacent to the electrode is to increase the “edginess” of the electrode surface, a concept that is explained and quantified by fractal mathematics. Rigorous finite element simulations were performed to compute the distribution of electric potential produced by proposed geometries, demonstrating that the neural activation function was significantly enhanced in the tissue. The activation of 800 model axons positioned around the electrodes was also quantified, showing that modified fractal geometries yielded a 22% reduction in input power consumption while maintaining the same level of neural activation. The results demonstrate the feasibility of increasing stimulation efficiency using modified fractal geometries beyond the levels already reported in the literature.

Efficacy and Safety of Pedunculopontine Nuclei (PPN) Deep Brain Stimulation in the Treatment of Gait Disorders: A Meta-Analysis of Clinical Studies

BACKGROUND Pedunculopontine nucleus (PPN) has complex reciprocal connections with basal ganglia, especially with internal globus pallidus and substantia nigra, and it has been postulated that PPN stimulation may improve gait instability and freezing of gait. In this meta-analysis, we will assess the evidence for PPN deep brain stimulation in treatment of gait and motor abnormalities especially focusing on Parkinson disease patients. METHODS PubMed and Scopus electronic databases were searched for related studies published before February 2014. Medline (1966-2014), Embase (1974-2010), CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases (1960-2014) were also searched for studies investigating effect of PPN deep brain stimulation in treatment of postural and postural instability and total of ten studies met the inclusion criteria for this analysis. RESULTS Our findings showed a significant improvement in postural instability (p<0.001) and motor symptoms of Parkinson disease on and off medications (p<0.05), but failed to show improvement in freezing of gait. CONCLUSIONS Despite significant improvement in postural instability observed in included studies, evidence from current literature is not sufficient to generalize these findings to the majority of patients.

Effect of Model Accuracy on the Result of Computed Current Densities in the Simulation of Transcranial Magnetic Stimulation

In this paper, we study the effects of model complexity on the accuracy of the results in the computer simulation of transcranial magnetic stimulation (TMS). The method has been extensively used in the last decade as a noninvasive technique to excite neurons in the brain by inducing weak electric currents in the tissue and proved to be a very promising alternative for currently invasive treatments in Parkinsons and Alzheimers diseases. A detailed 3-D model of a human head has been developed by combining individual patient-based brain images and the public domain Visible Human data consisting of brain white/gray matter, CSF, skull, and muscles. The finite-element method (low-frequency Ansoft Maxwell 3D package) is used to simulate the interaction of time-varying magnetic fields with brain tissues and to compute the densities of induced currents in different areas. Models with different levels of tissue separation have been developed and tested under the same condition to investigate the effects of model complexity on the distribution of fields and induced currents inside different tissues.

EFFECT OF REALISTIC MODELING OF DEEP BRAIN STIMULATION ON THE PREDICTION OF VOLUME OF ACTIVATED TISSUE

Deep brain stimulation (DBS) is a well-established treatment for Parkinsons disease, essential tremor and dystonia. It has also been successfully applied to treat various other neurological and psychiatric conditions including depression and obsessive-compulsive disorder. Numerous computational models, mostly based on the Finite Element Method (FEM) approach have been suggested to investigate the biophysical mechanisms of electromagnetic wave-tissue interaction during DBS. These models, although emphasizing the importance of various electrical and geometrical parameters, mostly have used simplified geometries over a tightly restricted tissue volume in the case of monopolar stimulation. In the present work we show that topological arrangements and geometrical properties of the model have a significant effect on the distribution of voltages in the concerned tissues. The results support reconsidering the current approach for modeling monopolar DBS which uses a restricted cubic area extended a few centimeters around the active electrode to predict the volume of activated tissue. We propose a new technique called multi-resolution FEM modeling, which may improve the accuracy of the prediction of volume of activated tissue and yet be computationally tractable on personal computers.

Feasibility of using linearly polarized rotating birdcage transmitters and close-fitting receive arrays in MRI to reduce SAR in the vicinity of deep brain simulation implants

MRI of patients with deep brain stimulation (DBS) implants is strictly limited due to safety concerns, including high levels of local specific absorption rate (SAR) of radiofrequency (RF) fields near the implant and related RF‐induced heating. This study demonstrates the feasibility of using a rotating linearly polarized birdcage transmitter and a 32‐channel close‐fit receive array to significantly reduce local SAR in MRI of DBS patients.

Construction and modeling of a reconfigurable MRI coil for lowering SAR in patients with deep brain stimulation implants

ABSTRACT Post‐operative MRI of patients with deep brain simulation (DBS) implants is useful to assess complications and diagnose comorbidities, however more than one third of medical centers do not perform MRIs on this patient population due to stringent safety restrictions and liability risks. A new system of reconfigurable magnetic resonance imaging head coil composed of a rotatable linearly‐polarized birdcage transmitter and a close‐fitting 32‐channel receive array is presented for low‐SAR imaging of patients with DBS implants. The novel system works by generating a region with low electric field magnitude and steering it to coincide with the DBS lead trajectory. We demonstrate that the new coil system substantially reduces the SAR amplification around DBS electrodes compared to commercially available circularly polarized coils in a cohort of 9 patient‐derived realistic DBS lead trajectories. We also show that the optimal coil configuration can be reliably identified from the image artifact on B1+ field maps. Our preliminary results suggest that such a system may provide a viable solution for high‐resolution imaging of DBS patients in the future. More data is needed to quantify safety limits and recommend imaging protocols before the novel coil system can be used on patients with DBS implants.

Local SAR near deep brain stimulation (DBS) electrodes at 64 and 127 MHz: A simulation study of the effect of extracranial loops

MRI may cause brain tissue around deep brain stimulation (DBS) electrodes to become excessively hot, causing lesions. The presence of extracranial loops in the DBS lead trajectory has been shown to affect the specific absorption rate (SAR) of the radiofrequency energy at the electrode tip, but experimental studies have reported controversial results. The goal of this study was to perform a systematic numerical study to provide a better understanding of the effects of extracranial loops in DBS leads on the local SAR during MRI at 64 and 127 MHz.

Combined use of transcranial magnetic stimulation and metal electrode implants: a theoretical assessment of safety considerations

This paper provides a theoretical assessment of the safety considerations encountered in the simultaneous use of transcranial magnetic stimulation (TMS) and neurological interventions involving implanted metallic electrodes, such as electrocorticography. Metal implants are subject to magnetic forces due to fast alternating magnetic fields produced by the TMS coil. The question of whether the mechanical movement of the implants leads to irreversible damage of brain tissue is addressed by an electromagnetic simulation which quantifies the magnitude of imposed magnetic forces. The assessment is followed by a careful mechanical analysis determining the maximum tolerable force which does not cause irreversible tissue damage. Results of this investigation provide useful information on the range of TMS stimulator output powers which can be safely used in patients having metallic implants. It is shown that conventional TMS applications can be considered safe when applied on patients with typical electrode implants as the induced stress in the brain tissue remains well below the limit of tissue damage.

A novel tablet computer platform for advanced language mapping during awake craniotomy procedures.

A computerized platform has been developed to enhance behavioral testing during intraoperative language mapping in awake craniotomy procedures. The system is uniquely compatible with the environmental demands of both the operating room and preoperative functional MRI (fMRI), thus providing standardized testing toward improving spatial agreement between the 2 brain mapping techniques. Details of the platform architecture, its advantages over traditional testing methods, and its use for language mapping are described. Four illustrative cases demonstrate the efficacy of using the testing platform to administer sophisticated language paradigms, and the spatial agreement between intraoperative mapping and preoperative fMRI results. The testing platform substantially improved the ability of the surgeon to detect and characterize language deficits. Use of a written word generation task to assess language production helped confirm areas of speech apraxia and speech arrest that were inadequately characterized or missed with the use of traditional paradigms, respectively. Preoperative fMRI of the analogous writing task was also assistive, displaying excellent spatial agreement with intraoperative mapping in all 4 cases. Sole use of traditional testing paradigms can be limiting during awake craniotomy procedures. Comprehensive assessment of language function will require additional use of more sophisticated and ecologically valid testing paradigms. The platform presented here provides a means to do so.

Parallel radiofrequency transmission at 3 tesla to improve safety in bilateral implanted wires in a heterogeneous model

Elongated implanted conductors can interact with the radiofrequency (RF) transmission field during MRI, posing safety concerns of excessive heating in patients with deep brain stimulators. A technique using parallel RF transmission (pTx) is evaluated on an anthropomorphic heterogeneous model with bilateral and unilateral curved wires.