Going Deeper with DBS

Deep brain stimulation (DBS) has been one of the most successful examples of implanted neurotechnology devices to reach the market. But as we report in this issue, the first generation of devices currently in use just scratches the surface in terms of efficacy and applications.

Succeeding generations of DBS systems will need a higher degree of placement accuracy, which is leading to new hardware, software, and imaging systems used in neurosurgery [see Warren Grill’s article, p1].
DBS systems also stand to benefit from many of the same advances in engineering and neurophysiology that are moving forward other forms of neurostimulation. This was the rationale for combining the 35th NIH Neural Prosthesis Workshop with the DBS Consortium meeting in Bethesda, MD this month [see conference report p7]. We were pleased to see representatives of both communities interacting in discussions of what’s needed in both fields.

Of particular value at this year’s Neural Interfaces Workshop were the panel discussions of features needed in future systems. Ali Rezai from the Cleveland Clinic certainly had the interests of his patients in mind when he called for an end to the “archaic crown of thorns” that characterizes current frame-based implantation surgery.

An intriguing, if futuristic, possibility for addressing this issue came out at the DBS Consortium dinner on the second night of the conference. Neurobiologist Rudolfo Llinas from New York University offered a sneak preview of early work toward development of a nanowire transvascular neural recording and stimulation device. Such a device would be inserted in an artery and migrated to its final resting place in the cerebral vasculature, a notion we discussed in this space 15 months ago [NBR Aug03 p2].

We also appreciated some of the comments contributed by attendees at the event. Erwin Montgomery from the University of Wisconsin-Madison pointed out a “deeper seated” problem confronting DBS, the “balkanization” of the healthcare industry and neurology in particular. He noted that neurology training programs are heavily biased toward pharmacological and genetic engineering approaches to the nervous system and relatively light on systems physiology. As a result, many regions of the country lack the facilities and base of well trained clinicians needed for the procedure to thrive. Adding to the problem, reimbursement for DBS is still insufficient. Facilities performing DBS implantation are paid one third of what they get for spine surgery, according to one estimate.

These issues point out some of the challenges—and some of the opportunities—confronting the DBS industry in the years ahead, challenges and opportunities that are best shared with other branches of neurotechnology.

James Cavuoto
Editor and Publisher