Theoretical considerations of deep brain stimulation programming

Abstract

Deep brain stimulation (DBS) is an effective surgical option for medically intractable movement disorders, such as Parkinson’s disease, dystonia, and tremor [1]. Proper diagnosis, timing of surgery and precise targeting are important factors for good clinical outcome of DBS. Unlike other surgery, clinical course of the DBS is not only determined by operation itself, but also by how electrical stimulations are performed after the operation [2-4]. In this review, DBS programming indicates adjusting parameters of electrical stimulation of DBS. Adjustment of DBS parameter is only a modifiable factor affecting clinical outcome of DBS [2,4]. However, many clinicians have difficulties in adjusting DBS parameters. This is because DBS parameters are not adjusted in clinical term, but have to be controlled in electrical or electrophysiological language [5]. Furthermore, mechanism of action how DBS improves symptoms of movement disorders is yet to be elucidated [6,7]. Therefore, most clinicians manage their patients who underwent DBS by personal experiences or anecdotal evidences rather than by understanding mechanisms of actions [4]. It is important to understand the mechanism of DBS not only because of the desire to know, but also because of future development of neuromodulation. In the future, DBS is highly likely to be developed as a surgical treatment for several functional brain disorders, such as pain, obsessive compulsive disorder, memory impairment, addiction, and depression [7]. If more complex brain network modulation is attempted without clearing up the confusion about the effect of DBS, there is a possibility that it will only increase confusion about why DBS is effective for these diseases. Received: July 28, 2021 Revised: August 27, 2021 Accepted: August 30, 2021