New Frontiers for Deep Brain Stimulation: Directionality, Sensing Technologies, Remote Programming, Robotic Stereotactic Assistance, Asleep Procedures, and Connectomics

Aristide Merola, Jaysingh Singh, Kevin Reeves, Barbara Changizi, Steven Goetz, Lorenzo Rossi, Srivatsan Pallavaram, Stephen Carcieri, Noam Harel, Ammar Shaikhouni, Francesco Sammartino, Vibhor Krishna, Leo Verhagen, Brian Dalm

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

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.

Original languageEnglish (US)
Article number694747
JournalFrontiers in Neurology
Volume12
DOIs
StatePublished - Jul 22 2021

Bibliographical note

Publisher Copyright:
© Copyright © 2021 Merola, Singh, Reeves, Changizi, Goetz, Rossi, Pallavaram, Carcieri, Harel, Shaikhouni, Sammartino, Krishna, Verhagen and Dalm.

Keywords

  • asleep
  • connectomics
  • deep brain stimulation
  • directionality
  • local field potential
  • robotic surgery
  • sensing
  • telemedicine

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