The results of the STN versus GPi “rematch” studies support the conclusion that bilateral STN DBS may not be the best option for every PD surgical patient. Such a tailored approach would include the options of targeting the GPi or choosing a unilateral operation.
#Fieldlines zero electric potential series#
Since 2005, a series of well-designed clinical trials and follow-up studies have addressed the question as to whether a more tailored approach to DBS therapy might improve overall outcomes. This bilateral STN “one-size-fits-all” approach was challenged by an editorial entitled “STN versus GPi: The Rematch,” which appeared in the Archives of Neurology in 2005. Whereas the GPi target does have a following, most centers have uniformly employed bilateral STN DBS for all PD cases. When formulating a DBS treatment plan for a patient with Parkinson's disease (PD), two critical questions should be addressed: (1) Which brain target should be chosen to optimize this patient's outcome? and (2) Should this patient's DBS operation be uni- or bilateral? Over the past two decades, two targets have emerged as leading contenders for PD DBS the STN and the globus pallidus internus (GPi).
Second, describe some of the technological developments that are currently underway in surgical targeting, stimulation parameter selection, stimulation protocols, and stimulation hardware that are being directly evaluated for near term clinical application. First, provide a general description of current clinical DBS practices, geared toward educating biomedical engineers and computer scientists on a field that needs their expertise and attention. This review attempts collate some of that progress and with two goals in mind. These interactions have helped to develop novel ideas for the next generation of clinical DBS systems. However, enhanced collaborations between neural engineers, neuroscientists, physicists, neurologists, and neurosurgeons are beginning to address some of the limitations of current DBS technology. The review is written from a technical perspective aimed at supporting the use of neurostimulation in clinical practice.ĭeep brain stimulation (DBS) has evolved into a powerful clinical therapy for a range of neurological disorders, but even with impressive clinical growth, DBS technology has been relatively stagnant over its history. This review provides an overview of the technical basis of neurostimulation focusing on the equipment, the present understanding of induced electric fields, and the stimulation protocols. Insight into the technical basis of neurostimulation might be a first step towards a more profound understanding of these mechanisms, which might lead to improved clinical outcome and therapeutic potential. The mechanisms of action of neurostimulation remain incompletely understood.
Brain neuromodulation involves different neurostimulation techniques: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), which are being used both to study their effects on cognitive brain functions and to treat neuropsychiatric disorders. Neuromodulation is a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies for the purpose of improving quality of life and functioning of humans.
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