A critical reflection on the technological development of deep brain stimulation (DBS)

Abstract

Since the translational research findings of Benabid and colleagues which partly led to their seminal paper regarding the treatment of mainly tremor-dominant Parkinson patients through thalamic high-frequency-stimulation (HFS) in 1987, we still struggle with identifying a satisfactory mechanistic explanation of the underlying principles of deep brain stimulation (DBS). Furthermore, the technological advance of DBS devices (electrodes and implantable pulse generators, IPG’s) has shown a distinct lack of dynamic progression. In light of this we argue that it is time to leave the paleolithic age and enter hellenistic times: the device-manufacturing industry and the medical community together should put more emphasis on advancing the technology rather than resting on their laurels.

Understanding the Effects and Adverse Reactions of Deep Brain Stimulation: Is It Time for a Paradigm Shift Toward a Focus on Heterogenous Biophysical Tissue Properties Instead of Electrode Design Only?

“…Future DBS leads should not only be characterized by a segmented nature, but also include the ability to measure the present electrical field expansion and thereby adapt to the local situation. Altogether, an effective model needs to take an interdisciplinary approach including knowledge from basic, preclinical and clinical research in order to effectively and ethically improve DBS interventions ( Ineichen et al, 2014 ). Mere knowledge of the electric field distribution itself is insufficient, and as such the development of functional models is equally important.…”

“…Moreover, the exact degree of electric field spread is unknown. Due to deficient knowledge on specific stimulation-effects, a good clinical outcome can only be obtained through a time-consuming adjustment of postoperative parameters ( Ineichen et al, 2014 ). This adjustment is largely based on phenotypic observation of the patient.…”

Comparing functional MRI protocols for small, iron‐rich basal ganglia nuclei such as the subthalamic nucleus at 7 T and 3 T

“…Deep brain stimulation (DBS) of BG nuclei, in particular the STN, is an important therapy in PD. However, the precise underlying mechanisms of this therapy are poorly understood and severe side‐effects can occur, possibly because of modulations of different cortical–subcortical loops than the motor control loop [Fasano and Lozano, ; Ineichen et al, ; Temel et al, ].…”

Analyzing 7000 texts on deep brain stimulation: what do they tell us?

“…Generally, the topic of ethical and social implications of technological devices is certainly an important one which, e.g., in the context of emerging closed-loop devices, will nourish further discussions in the future. Therefore, closely investigating ethical, social, and clinical aspects of the follow up process longitudinally, including e.g., the often challenging postoperative phase for precise DBS parameter adjustments (Ineichen et al, 2014 ) as well as fiscal and legal aspects of hardware replacement apart from ethical issues specifically in the context of hardware is important. In parallel, our result may emphasize not only a duty to investigate hardware related ethical issues which transcend merely and well-known technical problems (Christen et al, 2014 ) thoroughly, but also that ethical duties already instantiated also apply to engineers which represent key players and which are well-positioned to support the deployment of innovative hardware in order to diminish the burden of patients (Fins, 2009 ).…”