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Technological Advances in the Surgical Treatment of Movement Disorders

  • Movement Disorders (SA Factor, Section Editor)
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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 inserting 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 magnetic resonance imaging 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 computed tomography 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 biomarkers continuously recorded by the devices. Finer-grained DBS leads, in conjunction with new IPGs and advanced programming tools, may offer improved outcomes via current steering algorithms. Finally, even thermocoagulation—essentially replaced by DBS—is being advanced by new minimally-invasive 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.

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Conflict of Interest

Robert E. Gross declares board membership for NeuroPace, consultancy for Medtronic, Boston Scientific, St. Judes Medical Corp., Deep Brain Innovations, and Visualase, as well as speakers’ bureaus for Visualase and NeuroPace.

Margaret E. McDougal declares no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road, NE Suite 6200, Atlanta, GA, 30322, USA

    Robert E. Gross & Margaret E. McDougal

  2. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

    Robert E. Gross

  3. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA

    Robert E. Gross

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  1. Robert E. Gross
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Correspondence to Robert E. Gross.

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This article is part of the Topical Collection on Movement Disorders

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Gross, R.E., McDougal, M.E. Technological Advances in the Surgical Treatment of Movement Disorders. Curr Neurol Neurosci Rep 13, 371 (2013). https://doi.org/10.1007/s11910-013-0371-2

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