Neuromodulation for end of life symptoms

The future of neuromodulation shows incredible potential and will likely demonstrate greater integration of various techniques as adjunctive therapy to already accepted standard of care management. Extensive research continues on current applications of neuromodulation such as movement disorders, while new indications are also being investigated. These new indications include depression, obsessive-compulsive disorder, impulsivity disorders, addiction, eating disorders, obesity, tinnitus, blood pressure control and traumatic brain injury. In addition, neuromodulation may have a potential role in palliative care medicine. Patients in this sector often suffer from significantly distressing symptoms that have a common basis to some of those pathologies mentioned above. If effective, neuromodulatory techniques could alleviate these symptoms and facilitate a better quality of life for the patient’s remaining time. Here, we discuss the potential roles of neuromodulation by way of deep brain stimulation (DBS), motor cortex stimulation (MCS), spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS). These various modalities are examined for refractory symptoms of dyspnea, gastrointestinal (GI) dysfunction, motor deficits, depression, delirium, mentation and sleep disturbance in palliative care patients. We review discovery of incidental amelioration of symptoms, current knowledge on mechanism of action specific to modality, analysis of results reported in literature, limitations of data, barriers to application and future research. Many of the advances in functional neurosurgery have come from unintended benefits while treating other conditions and we suspect that increasing use of neuromodulation will result in similar findings of relief for other symptoms. It is an exciting time to be involved in neuromodulation as we seek to improve quality at end of life.