TY - JOUR
T1 - Deep brain stimulation programming strategies
T2 - segmented leads, independent current sources, and future technology
AU - Patel, Bhavana
AU - Chiu, Shannon
AU - Wong, Joshua K.
AU - Patterson, Addie
AU - Deeb, Wissam
AU - Burns, Matthew
AU - Zeilman, Pamela
AU - Wagle-Shukla, Aparna
AU - Almeida, Leonardo
AU - Okun, Michael S.
AU - Ramirez-Zamora, Adolfo
N1 - Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Introduction: Advances in neuromodulation and deep brain stimulation (DBS) technologies have facilitated opportunities for improved clinical benefit and side effect management. However, new technologies have added complexity to clinic-based DBS programming. Areas covered: In this article, we review basic basal ganglia physiology, proposed mechanisms of action and technical aspects of DBS. We discuss novel DBS technologies for movement disorders including the role of advanced imaging software, lead design, IPG design, novel programming techniques including directional stimulation and coordinated reset neuromodulation. Additional topics include the use of potential biomarkers, such as local field potentials, electrocorticography, and adaptive stimulation. We will also discuss future directions including optogenetically inspired DBS. Expert opinion: The introduction of DBS for the management of movement disorders has expanded treatment options. In parallel with our improved understanding of brain physiology and neuroanatomy, new technologies have emerged to address challenges associated with neuromodulation, including variable effectiveness, side-effects, and programming complexity. Advanced functional neuroanatomy, improved imaging, real-time neurophysiology, improved electrode designs, and novel programming techniques have collectively been driving improvements in DBS outcomes.
AB - Introduction: Advances in neuromodulation and deep brain stimulation (DBS) technologies have facilitated opportunities for improved clinical benefit and side effect management. However, new technologies have added complexity to clinic-based DBS programming. Areas covered: In this article, we review basic basal ganglia physiology, proposed mechanisms of action and technical aspects of DBS. We discuss novel DBS technologies for movement disorders including the role of advanced imaging software, lead design, IPG design, novel programming techniques including directional stimulation and coordinated reset neuromodulation. Additional topics include the use of potential biomarkers, such as local field potentials, electrocorticography, and adaptive stimulation. We will also discuss future directions including optogenetically inspired DBS. Expert opinion: The introduction of DBS for the management of movement disorders has expanded treatment options. In parallel with our improved understanding of brain physiology and neuroanatomy, new technologies have emerged to address challenges associated with neuromodulation, including variable effectiveness, side-effects, and programming complexity. Advanced functional neuroanatomy, improved imaging, real-time neurophysiology, improved electrode designs, and novel programming techniques have collectively been driving improvements in DBS outcomes.
KW - Deep brain stimulation
KW - Parkinson disease
KW - directional leads
KW - dystonia
KW - essential tremor
KW - multiple independent current control
KW - neurostimulation
UR - http://www.scopus.com/inward/record.url?scp=85114426216&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114426216&partnerID=8YFLogxK
U2 - 10.1080/17434440.2021.1962286
DO - 10.1080/17434440.2021.1962286
M3 - Review article
C2 - 34329566
AN - SCOPUS:85114426216
SN - 1743-4440
VL - 18
SP - 875
EP - 891
JO - Expert Review of Medical Devices
JF - Expert Review of Medical Devices
IS - 9
ER -