Update on Current Technologies for Deep Brain Stimulation in Parkinson's Disease

Abstract

Deep brain stimulation (DBS) is becoming increasingly central in the treatment of patients with Parkinson's disease and other movement disorders. Recent developments in DBS lead and implantable pulse generator design provide increased flexibility for programming, potentially improving the therapeutic benefit of stimulation. Directional DBS leads may increase the therapeutic window of stimulation by providing a means of avoiding current spread to structures that might give rise to stimulation-related side effects. Similarly, control of current to individual contacts on a DBS lead allows for shaping of the electric field produced between multiple active contacts. The following review aims to describe the recent developments in DBS system technology and the features of each commercially available DBS system. The advantages of each system are reviewed, and general considerations for choosing the most appropriate system are discussed.

Keywords: Deep brain stimulation; Parkinson disease; Surgery; Technology; Therapy.

Figure 1.

A: Stimulation of the dorsolateral STN through an ideally positioned DBS lead. B: Current steering through a directional DBS lead is unable to compensate for a misplaced lead that resides outside the target nucleus. C: Use of current steering through a directional lead that is positioned slightly posterior to the STN is capable of steering current toward the dorsolateral STN. STN: subthalamic nucleus, DBS: deep brain stimulation.

Figure 2.

Scaled visual representation of currently commercially available deep brain stimulation electrodes. The features and measurements of each lead type are summarized in Table 2.