DEEP BRAIN STIMULATION: PRINCIPLES, CLINICAL APPLICATIONS, OUTCOMES AND EMERGING TECHNOLOGIES

Abstract

Background: Deep brain stimulation (DBS) delivers chronic electrical stimulation to targeted brain circuits through implanted electrodes and a pulse generator. It is an established treatment for Parkinson disease, essential tremor and dystonia and is being investigated in epilepsy and psychiatric disorders.

Aim: To review the principles, surgical technique, clinical applications, outcomes, complications and emerging technologies of DBS. Methods: Narrative review of landmark randomized trials, meta-analyses and technical reviews.

Results: Randomized trials show that subthalamic stimulation is superior to best medical therapy in advanced Parkinson disease and in patients with early motor complications, and that stimulation of the anterior thalamic nucleus reduces seizures in refractory focal epilepsy (56% median reduction at two years). In a meta-analysis of 21,261 patients with Parkinson disease, infection (4.2%) and lead malposition (3.3%) were the most frequent complications and hemorrhage occurred in 2.4%. Evidence in psychiatric disorders is mostly open-label, and sham-controlled comparisons in depression have not shown a clear advantage of active stimulation. Adaptive (closed-loop) stimulation received US regulatory approval for Parkinson disease in 2025.

Conclusion: DBS is a safe and effective circuit-based therapy for selected patients, but better-designed trials are needed outside movement disorders.