Fundamentals of deep brain stimulation programming

Introduction This chapter will serve as a brief guide for clinicians taking care of patients with implanted deep brain stimulation (DBS) systems. We will discuss general principles that apply to all patients, regardless of their disease or site of stimulation in their brain. Other chapters will focus on programming issues specific to essential tremor (ET) (Chapter 6), Parkinson's disease (PD) (Chapter 7), and dystonia (Chapter 8), while the basic electrical principles underlying DBS are discussed in depth inChapter 4. It is not unusual for healthcare providers to be hesitant to embrace the management of DBS patients, as a common impression is that programming the stimulation system is complicated, time consuming, and highly technical. Though it is undeniable that programming DBS systems requires patience and persistence, it is also true that by applying a systematic approach one can move away from an inefficient and time consuming process with unpredictable results toward an efficient, effective, and successful programming session. In the following paragraphs we will first briefly describe the different components of available DBS systems that are relevant to the programmer. Next we will discuss the stimulation parameters that can be manipulated. Subsequently we will describe what will take place at the first postoperative visit when stimulation is initiated, and then what needs to be done during the follow-up programming visits. Before we proceed, it is important to emphasize that there are several different and valid programming strategies.