Discover how new technologies are helping doctors better tailor treatment to each patient.
Deep brain stimulation (DBS) has been used for patients with severe dystonia, who had no other treatment options, since the mid-1990s. At the end of the 1990s and in the early 2000s, clinical studies showed that DBS of the globus pallidus internus (GPi) is an effective treatment for generalised and segmental dystonia. Since the mid-2000s, DBS has become an established treatment option for patients with dystonia. Among all DBS indications, dystonia is now the third most common, after Parkinson’s disease and essential tremor. In recent years, DBS has continued to evolve, with a growing focus on more personalised and network-based approaches to better address the heterogeneity of dystonia.
In our Stereotactic department in Hamm (Germany), patients with dystonia have been treated with DBS from the very beginning of our program. When Dr. Lehrke started the DBS program in 2008, dystonia patients were included right away. Now, we regularly care for around 80 patients with dystonia. Our department performs roughly 50 DBS procedures every year. We start the programming of the DBS system already within the operating room. The days after the surgery we use to modify the stimulation parameters and the patients’ medication.
Before DBS is considered, patients are treated with medication and Botulinum toxin injections. If these options do not sufficiently improve the symptoms and patients remain clearly impaired in their daily life, our neurologists refer them to us for evaluation for DBS.
Patients with dystonia usually need more stimulation energy than patients with Parkinson’s disease. For this reason, the use of rechargeable neurostimulators in dystonia is more common, as they better accommodate higher energy needs and support long-term therapy management. We use all the devices available on the market.
In 2012, Boston Scientific entered the market with a rechargeable generator that offers independent current sources for each contact, a principle called Multiple Independent Current Control (MICC). When segmented directional electrodes were introduced, in 2015, this became a clear advantage: the stimulation current can be adapted more precisely within the GPi-target where it is needed, helping us to improve symptom control while reducing side effects.
In 2018, Guide XT was approved. This software further improved patient care by allowing the clinician to import each patient’s imaging data (both MRI and CT) into the programming process. In other words, the doctor has precise anatomical information in a 3D view where the electrodes are located, helping to make programming decisions with greater clarity and confidence. The field of stimulation can be visualized to control whether the target area is well covered or if the settings need to be adjusted. In this way, we can better understand exactly where the electrode is placed and how stimulation interacts with the brain structures involved in dystonia, which can vary from patient to patient.
This represents a shift towards a more individualized therapy, tailored to each patient’s anatomy.
The earlier segmented electrodes still had ring contacts at the tip and at the top. These ring contacts could not be used for directional stimulation. In 2025, Boston Scientific introduced the VerciseTM CartesiaTM HX electrode. This lead offers four levels of directional contacts, followed by four levels of ring contacts. Altogether, there are 16 contacts per lead, consisting of 12 directional and 4 ring contacts. This gives us even more flexibility to shape the stimulation field to the individual needs of each patient, dystonia included. Because there are now 16 contacts on each electrode, the new neurostimulator also needs to support more contacts – this led to the development of the VerciseTM Genus R32 system. There is also the VerciseTM Cartesia™ X lead which offers 5 level of directionality and one ring contact. Its directional span is more suitable for PD and ET patients, which have anatomical targets which are smaller.
In our centre, we have already implanted this new system in patients with tremor and with dystonia, and the results have been very encouraging, particularly in terms of programming flexibility and the ability to tailor stimulation more precisely. A new software called Illumina 3DTM, which is a further development of the programming platform, helps us to identify the best contacts for stimulation in relation to each patient’s individual brain anatomy, for a more precise and personalized programming approach.
The surgical procedure itself is very similar to the previous systems. At first, we were slightly concerned because the end of the electrode, which is usually placed behind the ear, is a bit longer and stiffer than with the conventional electrodes. During the operations we quickly learned that they
basically, can be handled in the same way. Overall, despite minor differences such as slightly thicker connectors, the system can be handled in a similar way to conventional electrodes, facilitating adoption in clinical practice.
To sum up, the new VerciseTM Cartesia™ X and Cartesia™ HX DBS systems are handled similarly to conventional systems during surgery, while offering significantly expanded programming possibilities. This allows for a more individualised and precise approach to DBS therapy, which may translate into improved symptom control and quality of life for patients living with dystonia. More broadly, these advancements reflect the ongoing evolution of DBS toward a more personalised treatment paradigm.
To learn more about dystonia and treatment options, scan the QR code or visit bostonscientific.eu/dystonia.
