EP 47. Three new techniques for improving DBS therapy: Controversies

Abstract

Question Steering DBS, adaptive DBS and coordinated reset neuromodulation the last fifteen years have been proposed as new techniques to improve the effect of DBS. Application of these techniques strongly depends on the design of the electronic devices. Why has the design of conventional pulse generators not changed up till now? Methods Steering DBS opens the possibility to steer the DBS current into a specific direction after implantation. A special high-density DBS lead and a multichannel programmable device is required. Adaptive DBS has the advantage of the adjustment of the stimulation amplitude depending on local field potential parameters. This requires a sensing possibility of the DBS equipment. Coordinated reset neuromodulation includes a different stimulation protocol with independent asynchronous stimulation on different contact points. Results All three new techniques have been tested experimentally per-operatively or shortly after neurosurgery. However, data on chronic stimulation are lacking since appropriate implantable pulse generators are missing. But also there is still uncertainty about how to implement these new techniques. More studies are needed on the advantage of steering DBS, on which local field potential parameters are most suitable for feedback ( Fig. 1 ) and on what is the best protocol to take optimum advantage of coordinated reset. Conclusions Very promising new techniques for DBS therapy are under development which have the potential of making DBS more efficient, leading to much smaller batteries and giving more possibilities on automatic adjustment of temporal and spatial stimulus parameters ( [Contarino et al., 2014] , [Bour et al., 2015] , [Lourens et al., 2015] , [Adamchic et al., 2014] , [Little et al., 2015] ).