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Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, Davidson B, Grill WM, Hariz MI, Horn A, Schulder M, Mammis A, Tass PA, Volkmann J, Lozano AM. Technology of deep brain stimulation: current status and future directions. Nat Rev Neurol 2020; 17:75-87. [PMID: 33244188 DOI: 10.1038/s41582-020-00426-z] [Citation(s) in RCA: 280] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/20/2023]
Abstract
Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation. DBS is a standard of care in Parkinson disease, essential tremor and dystonia, and is also under active investigation for other conditions linked to pathological circuitry, including major depressive disorder and Alzheimer disease. Modern DBS systems, borrowed from the cardiac field, consist of an intracranial electrode, an extension wire and a pulse generator, and have evolved slowly over the past two decades. Advances in engineering and imaging along with an improved understanding of brain disorders are poised to reshape how DBS is viewed and delivered to patients. Breakthroughs in electrode and battery designs, stimulation paradigms, closed-loop and on-demand stimulation, and sensing technologies are expected to enhance the efficacy and tolerability of DBS. In this Review, we provide a comprehensive overview of the technical development of DBS, from its origins to its future. Understanding the evolution of DBS technology helps put the currently available systems in perspective and allows us to predict the next major technological advances and hurdles in the field.
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Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Nir Lipsman
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Benjamin Davidson
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Marwan I Hariz
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Antonios Mammis
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jens Volkmann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.,Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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