New Frontiers for Deep Brain Stimulation: Directionality, Sensing Technologies, Remote Programming, Robotic Stereotactic Assistance, Asleep Procedures, and Connectomics
Open Access
- 22 July 2021
- journal article
- review article
- Published by Frontiers Media SA in Frontiers in Neurology
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.This publication has 168 references indexed in Scilit:
- The tremor network targeted by successful VIM deep brain stimulation in humansNeurology, 2012
- An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic SurgeryOperative Neurosurgery, 2012
- Target Identification for Stereotactic Thalamotomy Using Diffusion TractographyPLOS ONE, 2012
- Customized, Miniature Rapid-Prototype Stereotactic Frames for Use in Deep Brain Stimulator Surgery: Initial Clinical Methodology and Experience from 263 Patients from 2002 to 2008Stereotactic and Functional Neurosurgery, 2010
- An Assessment of Current Brain Targets for Deep Brain Stimulation Surgery With Susceptibility-Weighted Imaging at 7 TeslaNeurosurgery, 2010
- A role of diffusion tensor imaging in movement disorder surgeryActa Neurochirurgica, 2010
- Clinical Accuracy of a Customized Stereotactic Platform for Deep Brain Stimulation after Accounting for Brain ShiftStereotactic and Functional Neurosurgery, 2010
- Estimation of population firing rates and current source densities from laminar electrode recordingsJournal of Computational Neuroscience, 2007
- Deep brain stimulation in the internal capsule and nucleus accumbens region: responses observed during active and sham programmingJournal of Neurology, Neurosurgery & Psychiatry, 2006
- Bilateral Deep-Brain Stimulation of the Globus Pallidus in Primary Generalized DystoniaThe New England Journal of Medicine, 2005