One of the greatest technical challenges confronting the neurotechnology industry is identifying appropriate anatomical targets for neuromodulation, particularly for brain stimulation. In the few years that deep brain stimulation has been approved for treating neurological disorders, clinicians and researchers have used a number of different targets within the brain.
For individuals with Parkinson’s disease, DBS therapy has targeted either the subthalamic nucleus or the globus pallidus internus. A long-term study recently published in the New England Journal of Medicine seems to indicate that both targets are equally effective for treating PD [see article p5]. While this is good news for the DBS industry, since it offers more options for both clinicians and manufacturers, we should not be too quick to conclude that the choice of anatomical target for DBS is unimportant. In a detailed description of the study at the 2010 Neural Interfaces Conference earlier this month, William Marks from the University of California San Francisco explained that even though STN and GPi produced similar overall results, GPi stimulation had a different profile of improvement compared to STN [more detailed coverage of the conference will be published in the July issue of NBR].
A more revealing discussion by Cameron McIntyre of the Cleveland Clinic on computer modeling of DBS targeting drives home the point that selecting the right combination of brain targets and stimulation parameters will yield competitive advantages to vendors and therapeutic advantages to neurologists and neurosurgeons. For example, choosing stimulation parameters based on McIntyre’s model yielded a 66 percent power reduction. This promises to offer manufacturers devices with longer lifetimes and clinicians therapies with fewer side effects. The model also allows clinicians to visualize the brain targets for specific symptoms such as bradykinesia or rigidity. That promises clinicians a capacity for personalizing therapy for the needs of individual patients. And the software graphically depicts the changes in the volume of activated tissue expected by changing parameters such as voltage, current, or frequency, or pulsewidth.
The combination of new brain targets, optimized stimulation parameters, choice of leads, or contacts on a lead, and other factors will, we suspect, lead to a neuromodulation industry rich with different therapies. In the years ahead, we expect a rash of filings for new intellectual property seeking to protect unique combinations of location, stimulation parameters, and lead designs. In our view, there is room for as many new therapeutic approaches as there are ideas.
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