Industrial perspective on deep brain stimulation: history, current state, and future developments

Deep brain stimulation (DBS) emerged in the late 1960s as a possible therapeutic alternative to lesioning in patients with severe, chronic, intractable pain. DBS devices in the era were based on cardiac pacing technology but were greatly modified in implementation due to the unique needs of DBS. Clinical studies in the 1970s and early 1980s have revealed a technique with modest results which did not lead to regulatory approval for the treatment of pain. In the 1980s a new application for DBS emerged in the treatment of movement disorders. Clinical trials confirmed the robustness of the therapy leading to approvals by regulatory authorities in the US and Europe for the treatment of tremor and the symptoms of Parkinson’s disease. Technology based on that used for earlier clinical research in pain was improved by leveraging advances in cardiac pacing technology resulting in the sophisticated and reliable systems available today. In the 1990s scientific exploration began in the treatment of psychiatric disorders which is ongoing today. Simultaneously, studies into the treatment of epilepsy were begun which resulted in regulatory approval in Europe. Suggestions have been made to expand these scientific explorations to other central nervous system dysfunctions. Opportunity remains to improve the technology including individualized and symptom specific stimulation patterns, more physician and patient friendly programming, and possibly closed-loop systems for more situation dependent and effective therapy.

Totally implantable spinal cord stimulation for chronic pain: design and efficacy

Neurostimulators used to treat chronic, intractable pain have evolved from technical developments in pacemaker technology. A totally implantable spinal cord stimulation (SCS) system was designed based on elements of a widely used cardiac pacemaker. This paper reports on the transformation of pacemaker technology for neurostimulation applications and presents results of using this system for the treatment of 90 patients with chronic, intractable pain of the low back and/or legs. Significant reduction in pain levels resulted from use of a totally implantable spinal cord stimulation system. Seventy percent of the patients experienced good or excellent pain relief at an average of 14.5 months after implant. Patients who used an automatic ON/OFF cycling mode of stimulation reported greater pain relief than patients who were stimulated continuously.

Electrical brain stimulation for the control of chronic pain

An implanted brain stimulation system can be used for control of chronic intractable pain that is unresponsive to other forms of treatment. A trial period of temporary stimulation first determines whether a patient is likely to benefit from a permanent implant. Success has been achieved in the majority of patients, although technical problems have necessitated repairs.