How Many Patients would Benefit from Steering Technology for Deep Brain Stimulation?

Deep brain stimulation (DBS) is an effective treatment for movement disorders, including Parkinson's disease (PD), tremors and dystonia [ 1 ]. DBS efficacy may be limited by side-effects due to current spread into adjacent structures [ 2 ]. To overcome this issue, leads with smaller contacts have been designed that can steer stimulation into one direction. Pilot intraoperative studies have confirmed that stimulation steering can modulate thresholds for side-effects, thus widening the therapeutic window [ 3 , 4 ]. Although promising, these leads will likely be more expensive and require more complex, time-consuming procedures for the setup of stimulation parameters, as well as an update of the surgical implant techniques. Before this major modification of the clinical practice is implemented, the question arises regarding what proportion of patients would actually require such technology to achieve optimal benefit from DBS.