Review of directional leads, stimulation patterns and programming strategies for deep brain stimulation

Deep brain stimulation (DBS) is a well-established treatment for both neurological and psychiatric disorders. Directional DBS has the potential to minimize stimulation-induced side effects and maximize clinical benefits. Many new directional leads, stimulation patterns and programming strategies have been developed in recent years. Therefore, it is necessary to review new progress in directional DBS. This paper summarizes progress for directional DBS from the perspective of directional DBS leads, stimulation patterns, and programming strategies which are three key elements of DBS systems. Directional DBS leads are reviewed in electrode design and volume of tissue activated visualization strategies. Stimulation patterns are reviewed in stimulation parameters and advances in stimulation patterns. Programming strategies are reviewed in computational modeling, monopolar review, direction indicators and adaptive DBS. This review will provide a comprehensive overview of primary directional DBS leads, stimulation patterns and programming strategies, making it helpful for those who are developing DBS systems.