Technology of deep brain stimulation: current status and future directions

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. Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation and has become a standard of care in a range of movement disorders. This Review discusses the evolution and current status of DBS technology and anticipates future advances. Key points Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation and is commonly used for the treatment of movement disorders such as Parkinson disease, tremor and dystonia. Innovations in the field of cardiac pacemakers have enabled pulse generators for DBS to evolve from external devices to small rechargeable, implantable devices. With directional DBS leads, the current can be directed or shaped to personalize stimulation to individual anatomical structures. Closed-loop DBS systems simultaneously record and stimulate neural activity, allowing the stimulation to be adjusted according to disease-specific neural biomarkers. Open-access software can be used to localize DBS electrodes and, on the basis of the stimulation parameters, to model the volume of tissue activated around the electrodes, shedding light on key neurocircuitry elements. As DBS systems become compatible with wireless networks, remote programming by physicians will become possible but pri