Deep brain stimulation: new programming algorithms and teleprogramming

ABSTRACT

Introduction

Thanks to a variety of factors, the field of neuromodulation has evolved significantly over the past decade. Developments include new indications and innovations of hardware, software, and stimulation techniques leading to an expansion in scope and role of these techniques as powerful therapies. They also imply the realization that practical application involves new nuances that make patient selection, surgical technique, and the programming process even more complex, requiring continuous education and an organized structured approach.

Areas covered

In this review, the authors explore the developments in deep brain stimulation (DBS) technology, including electrodes, implantable pulse generators, contact configurations (i.e. directional leads and independent current control), remote programming, and sensing using local field potentials.

Expert opinion

The innovations in the field of DBS discussed in this review potentially provide increased effectiveness and flexibility not only to improve therapeutic response but also to address troubleshooting challenges seen in clinical practice. Directional leads and shorter pulse widths may broaden the therapeutic window of stimulation, avoiding current spread to structures that might trigger stimulation-related side effects. Similarly, independent control of current to individual contacts allows for the shaping of the electric field. Finally, sensing and remote programming represent important developments for more effective and individualized patient care.

KEYWORDS:

• Deep brain stimulation
• movement disorders
• DBS
• programming
• directional stimulation
• sensing
• remote programming

Article highlights

• After more than two decades of clinical experience, neuromodulation techniques are now well established in terms of their clinical indication, usefulness, and limitations.

• More recently, following several important developments, treatment algorithms have evolved to bring more flexibility to address different challenges at the expense of more complexity and need for continuous education in the field.

• There are currently substantial evidence-based data showing that combination of optimized dopaminergic replacement and neuromodulation therapies improve long-term outcomes.

• Directional leads and shorter PWs may broaden therapeutic window of stimulation, avoiding current spread to structures that might trigger stimulation-related side effects. Similarly, independent control of current to individual contacts allows for reshaping of the electric field. Finally, sensing and remote programming represent important developments for more effective and individualized patient care.

• Incorporation of these technical developments into clinical practice is essential to explore and confirm the potential effectiveness and safety.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.