Deep brain stimulation programming strategies: segmented leads, independent current sources, and future technology
Published in Expert Review of Medical Devices, 2021
Bhavana Patel, Shannon Chiu, Joshua K. Wong, Addie Patterson, Wissam Deeb, Matthew Burns, Pamela Zeilman, Aparna Wagle-Shukla, Leonardo Almeida, Michael S. Okun, Adolfo Ramirez-Zamora
The GPi is a triangular-shaped structure located in the inner part of the lentiform nucleus of the basal ganglia. It is bordered by the internal capsule (medial), the optic tract (ventral), the globus pallidus externa (GPe), and by the putamen (lateral) (Figure 5). The most common side effects from GPi-DBS are muscle contraction or dysarthria related to stimulation of the internal capsule either medially or posteriorly. Similar to the STN, the GPi may have functional territories whereby the dorsal GPi, GPe, and GPi-GPe border may elicit dyskinesia, and the deeper, more ventral parts may alleviate the cardinal motor symptoms [113,114]. Functionally, the striatal-pallidal efferent fibers converge on the GPi. Along with the substantia nigra pars reticulata (SNr), the GPi serves as the main basal ganglia output to the ventroanterior and ventrolateral thalamic nuclei, which in turn project to the cortex [83].