Deep Brain Stimulation for the Treatment of Movement Disorder Regarding Parkinson’s Disease and Essential Tremor with Device Characterization

Deep brain stimulation has provided an efficacious alternative for the treatment of progressive neurodegenerative movement disorders, such as Parkinson’s disease and Essential tremor, for more than a quarter of a century. This intervention strategy offers an adjustable and even reversible therapy by contrast to the permanency of lesion inducing neurosurgery, especially if medication has been deemed intractable. Furthermore, deep brain stimulation has been affirmed as a long-term means of suppressing movement disorder symptoms, although the foundational mechanisms remain to be conclusively ascertained. Target selection is specific to the type of neurodegenerative movement disorder diagnosed, and primary risks pertain to surgery and adverse effects resultant from the activation of stimulation. The general aspects that comprise the deep brain stimulation system are discussed from a system-level perspective, such as the implantable pulse generator, battery, connecting wire, and electrode lead. Even after the expert implantation of a deep brain stimulation system, the acquisition of an optimal parameter configuration presents a rather daunting and time-consuming process even for the highly talented and skilled clinician. The sheer quantity of permutations for optimizing parameters, such as polarity, amplitude of stimulation, rate of stimulation, and pulse width, presents a labor-intensive endeavor. The parameter configuration and operation of the deep brain stimulation system are modulated by the clinician programmer and patient programmer. Future concepts for deep brain stimulation are discussed, such as closed-loop acquisition of configuration parameters. Foundational to the perspective of deep brain stimulation optimization is the application of wearable and wireless systems, such as the smartphone, for objectively quantified feedback of movement disorder status. These envisioned technology evolutions advocate the prominence of Network Centric Therapy for the treatment of neurodegenerative movement disorders, such as Parkinson’s disease and Essential tremor.