In a new viewpoint article in JAMA Neurology, Michael S. Okun, M.D., chair of the department of neurology, discusses the complex challenge of selecting a deep brain stimulation, or DBS, system that is appropriate for an individual patient and for a specific symptom or set of symptoms.
“The lack of comparative studies among available devices and the absence of published guidelines in this decision process contribute to uncertainty and confusion among clinicians and patients,” writes Okun, executive director of the Norman Fixel Institute for Neurological Diseases at UF Health.
In the article, Okun highlights several tips and critical factors to help clinicians select the appropriate DBS device. These tips include:
- Determination of disease, the optimal brain target(s), and the approach (unilateral vs bilateral) may narrow the choice of device
- Assess access to programming and technical support
- A rechargeable device is not always the best option
- Decide on the likely need for future full-body magnetic resonance imaging
- Decide on the need for current steering or current shaping
- Choose a programming platform that the clinician is experienced and comfortable using in the office
“We suggest that the selection of the device should occur following multidisciplinary discussions that confirm diagnosis, identify optimal brain targets and determine unilateral vs bilateral approaches,” Okun writes.