Deep brain stimulation programming strategies: segmented leads, independent current sources, and future technology.

Area of Science:

• Neuromodulation and neurosurgery
• Neuroscience and neurophysiology
• Biomedical engineering

Background:

• Deep brain stimulation (DBS) has advanced, offering better clinical benefits and side effect management for movement disorders.
• New DBS technologies introduce complexity in programming, necessitating a review of current practices and future directions.

Purpose of the Study:

• To review fundamental basal ganglia physiology, proposed mechanisms of action, and technical aspects of DBS.
• To discuss novel DBS technologies for movement disorders, including advanced imaging, lead/IPG design, and programming techniques.
• To explore future directions in DBS, such as adaptive stimulation and optogenetically inspired approaches.

Main Methods:

• Review of basic basal ganglia physiology and proposed mechanisms of action for DBS.
• Discussion of technical aspects of DBS, including advanced imaging software, lead and IPG design.
• Exploration of novel programming techniques (directional stimulation, coordinated reset neuromodulation) and biomarkers (local field potentials, electrocorticography).

Main Results:

• Advances in DBS technologies, including imaging, hardware, and programming, are improving outcomes for movement disorders.
• Novel techniques like directional stimulation and coordinated reset neuromodulation, alongside biomarkers, enhance DBS efficacy and management.
• Emerging strategies like adaptive stimulation and optogenetically inspired DBS show promise for future treatment refinements.

Conclusions:

• DBS has expanded treatment options for movement disorders, with ongoing technological advancements addressing efficacy and programming challenges.
• Integration of improved neuroanatomy understanding, imaging, real-time neurophysiology, electrode design, and programming techniques drives progress in DBS.
• Future DBS development will likely focus on adaptive and personalized approaches for optimized patient outcomes.