Abstract
Over the last few years, while expanding its clinical indications from movement disorders to epilepsy and psychiatry, the field of deep brain stimulation (DBS) has seen significant innovations. Hardware developments have introduced directional leads to stimulate specific brain targets and sensing electrodes to determine optimal settings via feedback from local field potentials. In addition, variable-frequency stimulation and asynchronous high-frequency pulse trains have introduced new programming paradigms to efficiently desynchronize pathological neural circuitry and regulate dysfunctional brain networks not responsive to conventional settings. Overall, these innovations have provided clinicians with more anatomically accurate programming and closed-looped feedback to identify optimal strategies for neuromodulation. Simultaneously, software developments have simplified programming algorithms, introduced platforms for DBS remote management via telemedicine, and tools for estimating the volume of tissue activated within and outside the DBS targets. Finally, the surgical accuracy has improved thanks to intraoperative magnetic resonance or computerized tomography guidance, network-based imaging for DBS planning and targeting, and robotic-assisted surgery for ultra-accurate, millimetric lead placement. These technological and imaging advances have collectively optimized DBS outcomes and allowed “asleep” DBS procedures. Still, the short- and long-term outcomes of different implantable devices, surgical techniques, and asleep vs. awake procedures remain to be clarified. This expert review summarizes and critically discusses these recent innovations and their potential impact on the DBS field.
Highlights
Multiple innovations have improved the field of deep brain stimulation (DBS) over the last decade
With over 60,000 patients with Parkinson disease (PD), essential tremor (ET), dystonia, and Tourette syndrome implanted with DBS in the United States and more than 160,000 worldwide, DBS has demonstrated long-term efficacy on multiple aspects of movement disorders, including motor symptoms [1,2,3,4,5], quality of life [6], and quality-adjusted life expectancy (QALY) [7]
Consistent with anterior nucleus of the thalamus (ANT) location within the medial limbic circuit, the best seizure control effect of stimulation was seen for temporal lobe epilepsy (76% improvement) compared to epilepsies of the frontal lobes (59%) or other locations (68%)
Summary
Multiple innovations have improved the field of deep brain stimulation (DBS) over the last decade. Stimulation of the hippocampus has been investigated as a treatment for medial temporal lobe DRE not amenable for resection and has shown positive evidence of seizure reduction by 26–40% in small RCTs [23,24,25,26,27] and up to 95% in smaller non-randomized trials [20]. Case reports and case series have examined the use of DBS in other psychiatric conditions with severe and persistent symptoms, including anorexia nervosa, schizophrenia, bipolar disorder, and opioid use disorder [61,62,63] Results for these populations, who often lack evidence-based treatments for resistant illness, have been promising. To assist with the challenges associated with more complex programming strategies, DBS producers have developed
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