The Current State and Future Trajectory of Deep Brain Stimulation Technology
Deep brain stimulation (DBS) is a neurosurgical method that enables precise modulation of neural circuits. Widely used for conditions such as Parkinson’s disease, essential tremor, and dystonia, DBS is actively investigated for disorders associated with abnormal circuitry, including major depressive disorder and Alzheimer’s disease.
b | How we think the DBS setup might look in the future.
Intracranial Electrode
Modern DBS systems, inspired by cardiac technology, consist of an intracranial electrode, extension wire, and pulse generator, evolving gradually over the past two decades. Advances in engineering, imaging, and a deeper understanding of brain disorders are poised to transform how DBS is perceived and administered.
a | X-rays after surgery show a deep brain stimulation (DBS) system with electrodes and wires implanted in the neck and chest (left image), and the pulse generator implanted over the chest area (right image).
b | New MRI techniques, like quantitative susceptibility mapping (QSM) and fast grey matter acquisition T1 inversion recovery, make it easier to see subcortical structures. A QSM coronal slice highlights the subthalamic nucleus, a common target in Parkinson’s disease.
c | Advanced preoperative MRI, especially at ultra-high field strengths, is now used more for surgery planning and research. An axial slice with intrathalamic nuclei labeled is an example.
d | MRI shows metallic artifacts from DBS electrodes, visible on T2-weighted coronal and axial images. Specialized software can then reconstruct the electrodes in 3D. CT scans are also used for electrode localization. DBS settings help estimate the electric field around the electrodes (right image), and heuristic assumptions or axonal cable models estimate the activated tissue volume (VTA, red, right image).
e | The VTA is used in connectivity analyses, informed by resting-state functional MRI (top left) and diffusion-weighted imaging-based tractography (bottom left). This helps understand how DBS affects different brain regions. The labeled regions in the images include various thalamic nuclei and other structures.
Innovations
Anticipated innovations in electrode and battery designs, stimulation methods, closed-loop and on-demand strategies, and sensing technologies aim to enhance the effectiveness and tolerability of DBS. This comprehensive overview tracks the technical development of DBS, providing insights from its origins to future advancements. Grasping the technological evolution of DBS offers a context for existing systems and enables anticipation of significant progress and challenges in the field.
Read the Original Article: PubMed
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