Are we ready for automated deep brain stimulation programming?

Deep brain stimulation (DBS) requires individualized programming of stimulation parameters, a time-consuming process performed manually by clinicians with specialized training. This process limits DBS accessibility, delays treatment, and constrains the potential for next-generation technology to improve patient outcomes. This review describes technological advancements that could automate DBS programming, focusing on Parkinson's disease biomarkers that can provide objective outcome measurement and algorithms that can quickly and automatically identify optimal DBS settings. We first define key performance criteria for an automated programming system, including effectiveness, efficiency, and ease of use, and then describe and evaluate each component with respect to these criteria. We conclude that the state of current research provides a strong foundation for developing automated DBS programming. The primary remaining obstacle lies in identifying and deploying the best combination of available techniques that will overcome the high entry barrier needed for wide-scale clinical deployment and adoption.