Patient, target, device, and program selection for DBS in Parkinson’s disease: advancing toward precision care
Aparna Wagle Shukla, Manuel Bange, Muthuraman Muthuraman
Abstract
In Parkinson's disease (PD), several key factors influence patient selection for deep brain stimulation (DBS) as they directly affect long-term outcomes. A comprehensive interdisciplinary assessment is the first step to evaluating risks, benefits, and establishing appropriate goals. Patient-defined symptom priorities play a critical role in selecting the brain target for DBS. The entry of multiple manufacturers of hardware has spurred a rapid acceleration of technological progress. While innovations in programming such as sensing-based physiology-guided programming have introduced the concept of delivering an optimal or "Goldilocks dose", a precise, personalized therapy to address specific PD symptoms, image-guided programming acts like a "GPS," enabling faster determination of dose parameters. Emerging tools such as adaptive and automated programming offer clinicians the potential to provide optimal, energy-efficient stimulation. This review, integrating both old and well-established knowledge and new insights, provides a comprehensive summary of the multidimensional aspects of patient selection, target-specific benefits, advancements in hardware technology, and innovative strategies that are either currently available or on the horizon for DBS programming.