DBSの刺激調整法とデバイスの特徴

Programing of Deep Brain Stimulation and Features of Devices

Point

・刺激調整の基本は，各電極の症状改善閾値と副作用閾値を調べ（モノポーラ・レビュー），治療域の広い電極を使用することである．

・副作用出現時には症状と標的周囲の機能解剖とを照らし合わせ，原因となっている部位への刺激波及を避ける工夫をする．

・各デバイスが有するディレクショナル刺激，adaptive DBSなどの特殊な刺激方法を積極的に利用する．

　Deep brain stimulation（DBS）is an effective therapy for conditions involving drug-resistant involuntary movements, such as Parkinson's disease, tremor, and dystonia. Programming of DBS, as well as strict surgical indications, appropriate target selection, and accurate electrode placement, is one of the most important factors in the success of DBS. To obtain effective stimulation for a long period, it is important to expand the therapeutic window and reduce side effects. Recent advances in DBS devices have dramatically expanded the variety of stimulus settings. While the indication criteria of DBS and surgical techniques have been established, the details of the programming algorithm are not yet unified. In this paper, we describe the features of each device, basic programming methods, management of DBS-related side effects, and advanced stimulus methods.