From the Guidelines
Patients considering neurotechnological interventions, such as deep brain stimulation for Parkinson's disease or epilepsy, should adopt a comprehensive, multidisciplinary approach to decision-making, prioritizing thorough evaluation and consultation with specialists. This approach is crucial due to the lack of strong evidence supporting specific neurotechnological interventions for these conditions, as highlighted in recent guidelines 1. For instance, the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines for stroke rehabilitation, published in the Annals of Internal Medicine in 2025, note insufficient evidence to recommend for or against various treatments, including non-invasive brain stimulation and technology-based interventions 1.
When considering deep brain stimulation, patients with Parkinson's disease typically qualify when they experience significant motor fluctuations or dyskinesias despite optimal medical management, usually after several years of disease progression. Similarly, for epilepsy patients, neurostimulation options are considered after failing appropriate anti-seizure medications and when surgical resection is not feasible. The decision-making process should involve a thorough discussion of potential benefits, such as symptom reduction and decreased medication use, as well as risks, including infection, hemorrhage, and hardware complications.
Key aspects of the evaluation process include:
- Thorough consultation with a multidisciplinary team of specialists
- Comprehensive neuroimaging and neuropsychological testing
- Trial adjustments of medications over several months
- Detailed discussion of potential benefits and risks
Post-implantation care is also critical, with:
- Regular programming sessions to optimize stimulation parameters
- Ongoing medication adjustments
- Follow-up appointments initially every 2-4 weeks, then extending to every 3-6 months once stable
By prioritizing a comprehensive and multidisciplinary approach, patients can make informed decisions about neurotechnological interventions, weighing the potential benefits against the risks and ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Approach to Neurotechnological Interventions
For patients considering neurotechnological interventions, such as deep brain stimulation for Parkinson's disease or epilepsy, the following approach is recommended:
- Evaluate the patient's individual needs and preferences 2, 3
- Consider the different types of neurostimulation approaches available, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) 3, 4
- Assess the potential benefits and limitations of each approach, including the level of evidence supporting their use 2, 3, 4
- Discuss the potential risks and side effects associated with each approach, as well as the potential impact on quality of life 5
Patient Selection and Device Preference
Patient selection and device preference will depend on various factors, including:
- Patient preference and values 2
- Physician familiarity and expertise 2
- Individualized factors, such as the patient's medical history and lifestyle 2, 3
- The specific type and severity of the patient's condition, such as Parkinson's disease or epilepsy 3, 4, 5
Future Directions and Ethico-Legal Implications
The development and use of neurotechnological interventions also raises important ethico-legal implications, including:
- The need for anticipatory approaches to imagine potential future use cases and implications 6
- The importance of considering potential consumer uses of devices and their potential impact on legal and policy contexts 6
- The need for co-responsibility and balanced policy responses that take into account knowledge, values, innovation potential, and regulatory safeguards 6