Comprehensive Summary
This article explores the field of multitarget deep-brain stimulation (DBS) as a strategy to treat neurological and psychiatric disorders. This involves distributed brain networks rather than just isolated regions. Traditional DBS has largely focused on single targets, such as the subthalamic nucleus in Parkinson’s disease or the anterior limb of the internal capsule in depression, but many symptoms patients suffer from arise from dysfunction across multiple interconnected nodes. The authors outline how multitarget stimulation may offer broader therapeutic benefits, whether through electrodes capable of engaging more than one brain structure or coordinating multiple stimulation sites. They discuss several technological advances that make this possible, including flexible electrode designs, programming strategies that allow dynamic switching between targets, and the development of closed-loop systems that use physiological feedback signals to adapt stimulation in real time. Integration of brain connectivity data from neuroimaging and electrophysiology is a way to refine target selection and optimize outcomes. The article also highlights challenges such as device miniaturization, long-term stability, safety considerations, and the complexity of clinical trial design for multitarget therapies. Overall, the article frames multitarget DBS as a promising shift from region-specific interventions toward network-based neuromodulation, aligning treatment strategies more closely with the distributed nature of brain disorders.
Outcomes and Implications
The move toward multitarget DBS has important implications for clinical practice. By focusing on networks rather than single brain structures, physicians may be able to address complex and overlapping symptoms more effectively, particularly in disorders like Parkinson’s disease, depression, obsessive–compulsive disorder, and chronic pain, where multiple circuits contribute to the pathology. Additionally, connectivity-based approaches could allow personalization of neuromodulation, tailoring stimulation to each patient’s unique brain networks, identified through imaging and electrophysiology. Closed-loop stimulation offers the potential to adjust therapy dynamically, improving efficacy while minimizing side effects and power consumption. This could extend device lifespan as well as reduce the need for surgical replacements.However, the clinical translation of these approaches will require overcoming substantial technological hurdles, such as designing electrodes that can safely and precisely stimulate multiple regions, and strategies for long-term stability and safety. For clinicians, this shift underscores the importance of adopting a multidisciplinary perspective that combines neurology, psychiatry, neurosurgery, and engineering to deliver the best care. Ultimately, multitarget DBS could expand therapeutic options, improve outcomes, and enhance quality of life for patients whose conditions are inadequately addressed by a single-target stimulation approach.