Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

Abstract

Deep brain stimulation (DBS) is becoming increasingly central in the treatment of patients with Parkinson’s disease and other movement disorders. Recent developments in DBS lead and implantable pulse generator design provide increased flexibility for programming, potentially improving the therapeutic benefit of stimulation. Directional DBS leads may increase the therapeutic window of stimulation by providing a means of avoiding current spread to structures that might give rise to stimulation-related side effects. Similarly, control of current to individual contacts on a DBS lead allows for shaping of the electric field produced between multiple active contacts. The following review aims to describe the recent developments in DBS system technology and the features of each commercially available DBS system. The advantages of each system are reviewed, and general considerations for choosing the most appropriate system are discussed.

Longevity of Deep Brain Stimulation Batteries; a Global Survey of Neurosurgeons and Neurologists

“…The anti-geronic protein α-Klotho (referred to as Klotho), plays a potential role in delaying age-related declines in cellular and tissue function, which has generated considerable interest in targeting this protein for the treatment of agerelated neurodegenerative diseases. 1 Systemic exogenous elevation of Klotho enhances cognition and neural resilience in young, aging, and in vivo models of Parkinson's disease (PD). [2][3][4] Interestingly, in addition to age-related abnormalities, cognitive decline, and premature death, Klotho-deficient mice display nigrostriatal neurodegeneration, a hallmark of PD.…”

“…and 2011, the company replaced the original IPGs with new ones, the ActivaPC and ActivaSC. Although the marketed lifespan of the batteries of the new brands was advertised as being longer than the older ones, 1 several studies eventually reported that the lifespan of the newer IPGs was in fact significantly shorter than that of its predecessors (Supplementary Table S1). This has been questioned by the company.…”

“…Although there are currently several DBS manufacturers (Medtronic Inc, Minneapolis, Mn, USA), the hardware of the historically oldest DBS company is still the most prevalent. 1 Its original implantable pulse generators (IPGs), the dual channel Kinetra and the single channel Soletra, were used in many trials, including in the randomized blinded trials of DBS for PD and dystonia that established globally this procedure. Between 2009 and 2011, the company replaced the original IPGs with new ones, the ActivaPC and ActivaSC.…”

An Update on Medical and Surgical Treatments of Parkinson’s Disease

“…There are three manufacturers with approved devices in the USA [117,118]. Medtronic was approved for use in PD in 2002, the Abbott Infinity system was approved in 2016 followed by the approval of the Boston Scientific Vercise system.…”

Basic Tips: How Do I Start Programming Deep Brain Stimulation in Parkinson Disease Patients?

“…1, Table 1). 3,4 These advances have come with a price: programming has become even more complex, 5 emphasizing even more the need for a structured approach (Table 2).…”