Deep brain stimulation (DBS) is an effective treatment for common movement disorders and has been used to modulate neural activity through delivery of electrical stimulation to key brain structures. The long-term efficacy of stimulation in treating disorders, such as Parkinson’s disease and essential tremor, has encouraged its application to a wide range of neurological and psychiatric conditions. Nevertheless, adoption of DBS remains limited, even in Parkinson’s disease. Recent failed clinical trials of DBS in major depression, and modest treatment outcomes in dementia and epilepsy, are spurring further development. These improvements focus on interaction with disease circuits through complementary, spatially and temporally specific approaches. Spatial specificity is promoted by the use of segmented electrodes and field steering, and temporal specificity involves the delivery of patterned stimulation, mostly controlled through disease-related feedback. Underpinning these developments are new insights into brain structure–function relationships and aberrant circuit dynamics, including new methods with which to assess and refine the clinical effects of stimulation.
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This work was supported by the Medical Research Council UK (MC_UU_12024/1 1188 to P.B. and MR/R020418/1 to H.C.). T.D. is supported by the Royal Academy of Engineering through a chair in emerging technology. C.M. is supported by NIH R01 NS086100.
C.M. is a shareholder in Surgical Information Sciences, Hologram Consultants, Cortics, Autonomic Technologies, Cardionomic and Enspire DBS, as well as a paid consultant to Boston Scientific Neuromodulation. C.M. has intellectual property directly related to the areas we discuss and receives royalties from Neuros Medical, Boston Scientific, Hologram Consultants and Qr8 Health. T.D. is a shareholder in Medtronic, is a consultant for Inspire Medical and Cortec Neurotechnologies, is an advisor for Nia therapeutics, and has intellectual property directly related to the areas we discuss. P.B. has intellectual property directly related to the areas we discuss. H.C. has intellectual property directly related to the areas we discuss.
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Cagnan, H., Denison, T., McIntyre, C. et al. Emerging technologies for improved deep brain stimulation. Nat Biotechnol 37, 1024–1033 (2019). https://doi.org/10.1038/s41587-019-0244-6
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