Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies

Abstract

This paper provides an overview of current progress in the technological advances and the use of deep brain stimulation (DBS) to treat neurological and neuropsychiatric disorders, as presented by participants of the Fourth Annual DBS Think Tank, which was convened in March 2016 in conjunction with the Center for Movement Disorders and Neurorestoration at the University of Florida, Gainesveille FL, USA. The Think Tank discussions first focused on policy and advocacy in DBS research and clinical practice, formation of registries, and issues involving the use of DBS in the treatment of Tourette Syndrome. Next, advances in the use of neuroimaging and electrochemical markers to enhance DBS specificity were addressed. Updates on ongoing use and developments of DBS for the treatment of Parkinson's disease, essential tremor, Alzheimer's disease, depression, post-traumatic stress disorder, obesity, addiction were presented, and progress toward innovation(s) in closed-loop applications were discussed. Each section of these proceedings provides updates and highlights of new information as presented at this year's international Think Tank, with a view toward current and near future advancement of the field.

The role of deep brain stimulation in Parkinson’s disease: an overview and update on new developments

“…Presently, clinicians have the ability to change active contact configurations from simple monopolar settings to bipolar and to employ interleaving, a technique that allows two different programs to run alternatively. Impending new DBS lead technology will allow some degree of “current steering” or the ability to apply current in other than a concentric ring around the activated contact(s) as is the case with the current four-contact lead 75,90. Most future DBS electrodes also will have more than four contacts, allowing for finer control of the stimulated areas.…”

“…Because this study was performed only intraoperatively, there was no evaluation to determine whether this difference could be maintained long term. Other impending leads produced by Boston Scientific with eight contacts have the potential for independent current sources allowing for separate manipulation of the typical DBS parameters (amplitude, frequency, pulse width, and current) at each contact 75,90. This technology has already been approved for use in Europe.…”

“…However, the potential to shield some brain regions with current shaping and steering may be useful to lower the side effects. Potential negatives to this exciting technology include increased programming time with further programming alternatives, the degree of the programmer’s accuracy in “steering” the electrical current to the needed areas, and the fact that the decreased surface area due to the smaller size of the contacts will inevitably increase impedances, potentially leading to greater consumption of battery power 75,90…”

“…However, in a similar fashion to the way modern cardiac pacemakers can change output patterns depending upon input from sensors of heart rhythm, DBS devices are being developed that can utilize input from brain activity through a so-called closed-loop system 95,96. This emerging technology is still early in the development cycle, but potential applications are multifold 75,90,97. A major limitation, however, is still determining what the brain activity or “input signal” is to trigger the appropriate change in the DBS system 75.…”

“…Potential uses of this new technology could include prolonging battery life by reducing output during sleep and less needed times as well as delivering different output during times when things like freezing occur to “unfreeze” the patient. Also, bothersome motor features and dyskinesias could be more effectively managed in relation to PD medication dosing times 75,90,97…”