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Programming: General Aspects

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Fundamentals and Clinics of Deep Brain Stimulation

Abstract

Over the past two decades, a great deal has been learned about how the brain responses to the individual deep brain stimulation (DBS) pulse, although which of those underlie benefit or adverse effects is unclear. It is now generally known that the primary effect is generating action potentials in axons in the vicinity of the DBS cathode (negative contact). The DBS pulse does so by depolarizing the cell membrane of the neuronal axon to initiate openings of voltage-gated ionic conductance channels, primarily on the axons.

The electronics of the DBS systems, current (voltage in the case of constant voltage stimulation), pulse width, and neuronal biophysics can be leveraged to optimize DBS programming. The primary responses to the DBS pulse initiate cascades of effects that percolate throughout the system, both antidromically and orthodromically. These are referred to as secondary effects and likely are critical for the clinical benefit. In some cases, the percolating effects produce recurrent effects creating oscillatory activities and interactions among them. Whereas the current and pulse width are critical to the primary effects, it is likely that the DBS frequency is critical to the secondary effects. Thus, frequency must be considered as a separate control parameter relatively independent of the current and pulse width and thus, the total electrical energy delivered (TEED) is not an appropriate consideration.

Effective and efficient DBS programming has to be considered in its widest ecology. Programming is not just a matter of adjusting current, pulse width, frequency, and the pattern of active contacts. Indeed, in disorders such as Parkinson’s disease, the synergies between DBS and other treatments have to be managed. The tools required include not only the DBS programming device, but also tools to assess the DBS effects, particularly in the context of complicating factors and the logistical constraints of the DBS programming session. Yet, there is considerable evidence that proper DBS programming can make a dramatic change in the lives of patients.

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Authors and Affiliations

  1. Movement Disorders Unit, Division of Neurology, Departamento de Medicina Integrada, Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Natal, RN, Brazil

    Clecio de Oliveira Godeiro Jr

  2. Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble, CS, France

    Elena Moro

  3. Division of Neurology, Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Erwin B. Montgomery Jr

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  1. Clecio de Oliveira Godeiro Jr
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  2. Elena Moro
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Correspondence to Erwin B. Montgomery Jr .

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Editors and Affiliations

  1. Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands

    Yasin Temel

  2. Department of Psychiatry, Maastricht University Medical Centre, Maastricht, The Netherlands

    Albert F.G. Leentjens

  3. Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands

    Rob M.A. de Bie

  4. Department of Neurosurgery, Grenoble University Hospital Center, Grenoble, France

    Stephan Chabardes

  5. Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada

    Alfonso Fasano

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de Oliveira Godeiro, C., Moro, E., Montgomery, E.B. (2020). Programming: General Aspects. In: Temel, Y., Leentjens, A., de Bie, R., Chabardes, S., Fasano, A. (eds) Fundamentals and Clinics of Deep Brain Stimulation. Springer, Cham. https://doi.org/10.1007/978-3-030-36346-8_8

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