Introduction: Thanks to a variety of factors, the field of neuromodulation has evolved significantly over the past decade. Developments include new indications and innovations of hardware, software, and stimulation techniques leading to an expansion in scope and role of these techniques as powerful therapies. They also imply the realization that practical application involves new nuances that make patient selection, surgical technique, and the programming process even more complex, requiring continuous education and an organized structured approach.
Areas covered: In this review, the authors explore the developments in deep brain stimulation (DBS) technology, including electrodes, implantable pulse generators, contact configurations (i.e. directional leads and independent current control), remote programming, and sensing using local field potentials.
Expert opinion: The innovations in the field of DBS discussed in this review potentially provide increased effectiveness and flexibility not only to improve therapeutic response but also to address troubleshooting challenges seen in clinical practice. Directional leads and shorter pulse widths may broaden the therapeutic window of stimulation, avoiding current spread to structures that might trigger stimulation-related side effects. Similarly, independent control of current to individual contacts allows for the shaping of the electric field. Finally, sensing and remote programming represent important developments for more effective and individualized patient care.
Keywords: DBS; Deep brain stimulation; directional stimulation; movement disorders; programming; remote programming; sensing.