Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and “connectomics” will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
Highlights
Deep brain stimulation (DBS) has evolved substantially over the past several decades
In ventral intermediate (VIM)-DBS for tremor, studies found that a long absence of stimulation leads to worse symptom suppression compared to conventional DBS [167], but a well-organized, temporally irregular stimulation with lower average frequency is able to achieve the same outcome as conventional high-frequency stimulation while reducing the total energy consumed by the implantable pulse generator (IPG) [168]
Improvements in lead design has allowed segmented contacts to be used for directional stimulation, and improvements in IPG design have led to smaller, longer-lasting, batteries that are MRI compatible
Summary
Deep brain stimulation (DBS) has evolved substantially over the past several decades. Advances in anatomical atlases, imaging sequences, and connectomics are refining the methods used across centers to improve surgical targeting and to ensure accurate DBS electrode placement for therapeutic benefit. The model of the effect of stimulation provides an estimate of the spatial extent of activation based on the applied stimulation parameters (contact configuration, amplitude, pulse width, and frequency) and the anatomical location of the DBS electrode.
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