Technological Advances in the Surgical Treatment of Movement Disorders

• Type of Material: Article
• Authors: Robert Gross, Emory University; Margaret E. McDougal, Emory University
• Language: English
• Date: 2013-08
• Publisher: Current Medicine Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Springer Science+Business Media New York 2013
• Final Published Version (URL): http://link.springer.com/article/10.1007%2Fs11910-013-0371-2
• Title of Journal or Parent Work: Current Neurology and Neuroscience Reports
• ISSN: 1528-4042
• Volume: 13
• Issue: 8
• Start Page: 371
• End Page: 371
• Keywords: closed-loop neuromodulation; constant current; MRI; Deep brain stimulation
• Research Categories: Engineering, Biomedical; Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Technological innovations have driven the advancement of the surgical treatment of movement disorders, from the invention of the stereotactic frame to the adaptation of deep brain stimulation (DBS). Along these lines, this review will describe recent advances in getting neuromodulation modalities, including DBS, to the target; and in the delivery of therapy at the target. Recent radiological advances are altering the way that DBS leads are targeted and inserted, by refining the ability to visualize the subcortical targets using high-field strength MRI and other innovations such as diffusion tensor imaging, and the development of novel targeting devices enabling purely anatomical implantations without the need for neurophysiological monitoring. New portable CT scanners also are facilitating lead implantation without monitoring as well as improving radiological verification of DBS lead location. Advances in neurophysiological mapping include efforts to develop automatic target verification algorithms, and probabilistic maps to guide target selection. The delivery of therapy at the target is being improved by the development of the next generation of internal pulse generators (IPGs). These include constant current devices that mitigate the variability introduced by impedance changes of the stimulated tissue, and in the near future, devices that deliver novel stimulation patterns with improved efficiency. Closed-loop adaptive IPGs are being tested, which may tailor stimulation to ongoing changes in the nervous system reflected in Œbiomarkers1 continuously recorded by the devices. Finer grained DBS leads, in conjunction with new IPGs and advanced programming tools, may offer improved outcomes via Œcurrent steering1 algorithms. Finally, even thermocoagulation - essentially replaced by DBS - is being advanced by new Œminimally-invasive1 approaches that may improve this therapy for selected patients in whom it may be preferred. Functional neurosurgery has a history of being driven by technological innovation, a tradition that continues into its future.