On 2014 May 31, David Keller commented:

Can Directional DBS be combined with Adaptive DBS to further optimize therapeutic effects?

Directional DBS was shown to provide a therapeutic window 41.3% wider than for standard omnidirectional DBS, and to achieve this with a smaller electrode; this new technique seems to offer significant improvements over standard DBS.

Standard DBS is observed to cause a syndrome of mild loss of verbal fluency due to the small amount of brain damage caused by the placement of the leads. Does the smaller lead size employed for directional DBS reduce this adverse side effect compared with standard lead placement surgery?

Because it requires a new electrode, patients with pre-existing omnidirectional DBS will likely require repeat stereotactic neurosurgery to replace their brain leads when and if they need an upgrade to directional DBS. Waiting for directional DBS to be approved may be a reasonable choice for patients who can defer DBS.

Recently, another new technique known as adaptive DBS (aDBS) was also demonstrated to provide meaningful improvements over standard DBS (1). aDBS involves using feedback from a pathological brain electrical signal to modulate the applied DBS signal, and it also serves to reduce the required electrical signal to achieve therapeutic effects.

An obvious question arises: can we combine directional DBS with adaptive DBS, in order to more fully optimize their therapeutic effects? The answer to that question, according to Peter Brown, Professor of Experimental Neurology at University of Oxford, and principal investigator on the team which developed aDBS, is "I agree that the two could be usefully combined in the future" (2). I invite the scientists who developed dDBS to add their assessment of the utility of combining these 2 techniques, and to consider a collaborative effort with Dr. Brown to do so.

Reference

1: Little S, Pogosyan A, Neal S, Zavala B, Zrinzo L, Hariz M, Foltynie T, Limousin P, Ashkan K, FitzGerald J, Green AL, Aziz TZ, Brown P. Adaptive deep brain stimulation in advanced Parkinson disease. Ann Neurol. 2013 Sep;74(3):449-57. doi: 10.1002/ana.23951. Epub 2013 Jul 12. PubMed PMID: 23852650; PubMed Central PMCID: PMC3886292.

2: Brown P, private correspondence, June 1, 2014

On 2014 May 31, David Keller commented:

Can Directional DBS be combined with Adaptive DBS to further optimize therapeutic effects?

Directional DBS was shown to provide a therapeutic window 41.3% wider than for standard omnidirectional DBS, and to achieve this with a smaller electrode; this new technique seems to offer significant improvements over standard DBS.

Standard DBS is observed to cause a syndrome of mild loss of verbal fluency due to the small amount of brain damage caused by the placement of the leads. Does the smaller lead size employed for directional DBS reduce this adverse side effect compared with standard lead placement surgery?

Because it requires a new electrode, patients with pre-existing omnidirectional DBS will likely require repeat stereotactic neurosurgery to replace their brain leads when and if they need an upgrade to directional DBS. Waiting for directional DBS to be approved may be a reasonable choice for patients who can defer DBS.

Recently, another new technique known as adaptive DBS (aDBS) was also demonstrated to provide meaningful improvements over standard DBS (1). aDBS involves using feedback from a pathological brain electrical signal to modulate the applied DBS signal, and it also serves to reduce the required electrical signal to achieve therapeutic effects.

An obvious question arises: can we combine directional DBS with adaptive DBS, in order to more fully optimize their therapeutic effects? The answer to that question, according to Peter Brown, Professor of Experimental Neurology at University of Oxford, and principal investigator on the team which developed aDBS, is "I agree that the two could be usefully combined in the future" (2). I invite the scientists who developed dDBS to add their assessment of the utility of combining these 2 techniques, and to consider a collaborative effort with Dr. Brown to do so.

Reference

1: Little S, Pogosyan A, Neal S, Zavala B, Zrinzo L, Hariz M, Foltynie T, Limousin P, Ashkan K, FitzGerald J, Green AL, Aziz TZ, Brown P. Adaptive deep brain stimulation in advanced Parkinson disease. Ann Neurol. 2013 Sep;74(3):449-57. doi: 10.1002/ana.23951. Epub 2013 Jul 12. PubMed PMID: 23852650; PubMed Central PMCID: PMC3886292.

2: Brown P, private correspondence, June 1, 2014