Current Directions in Deep Brain Stimulation for Parkinson's Disease-Directing Current to Maximize Clinical Benefit.

Neurology and Therapy
Aristide MerolaLeo Verhagen

Abstract

Several single-center studies and one large multicenter clinical trial demonstrated that directional deep brain stimulation (DBS) could optimize the volume of tissue activated (VTA) based on the individual placement of the lead in relation to the target. The ability to generate axially asymmetric fields of stimulation translates into a broader therapeutic window (TW) compared to conventional DBS. However, changing the shape and surface of stimulating electrodes (directional segmented vs. conventional ring-shaped) also demands a revision of the programming strategies employed for DBS programming. Model-based approaches have been used to predict the shape of the VTA, which can be visualized on standardized neuroimaging atlases or individual magnetic resonance imaging. While potentially useful for optimizing clinical care, these systems remain limited by factors such as patient-specific anatomical variability, postsurgical lead migrations, and inability to account for individual contact impedances and orientation of the systems of fibers surrounding the electrode. Alternative programming tools based on the functional assessment of stimulation-induced clinical benefits and side effects allow one to collect and analyze data from eac...Continue Reading

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Citations

Apr 25, 2020·Biomolecules·Farzad Salehpour, Michael R Hamblin
Nov 9, 2020·Neuromodulation : Journal of the International Neuromodulation Society·Kantharuby Tambirajoo, Keyoumars Ashkan
Mar 19, 2021·Neuromodulation : Journal of the International Neuromodulation Society·Richard A RammoBenjamin L Walter
Jun 10, 2021·Neuromodulation : Journal of the International Neuromodulation Society·Jason YuenYoonbae Oh
Jul 31, 2021·Expert Review of Medical Devices·Bhavana PatelAdolfo Ramirez-Zamora

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Software Mentioned

[UNK]
Neural Navigator
VTA
BrainLab
StimDirect
BrainLab Elements
XT

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