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

7 Scopus citations


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
StatePublished - Jul 22 2021

Bibliographical note

Funding Information:
Conflict of Interest: AM has received support from the NIH (KL2 TR001426), speaker honoraria from CSL Behring, Abbvie, Abbott, Theravance, and Cynapsus Therapeutics. He has received a salary as chief Editor of Frontiers in Neurology, Experimental Therapeutics, and grant support from Lundbeck and Abbvie. BC has received speaker honoraria from Abbvie. SG is an employee at Medtronic. LR is an employee and shareholder in Newronika, Inc. SP is an employee of Abbott Laboratories. SC is an employee of Boston Scientific. NH is co-founder, and shareholder in Surgical Information Sciences, Inc. VK has received grant support from Medtronic. LV is an editorial board member of Neurology and Therapy, and Brain Sciences. He has received consultant honoraria from Abbott, AbbVie Inc, and Boston Scientific, and research support from Medtronic, Boston Scientific, Abbott, AbbVie, Neuroderm, Biogen Inc. He has received NIH funding (R01 NS40902) as a site-PI.

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


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

PubMed: MeSH publication types

  • Journal Article
  • Review


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