After activation, the DBS programmer can tele-metrically set the device to one of thousands of different stimulation combinations. The device may be reprogrammed as often as necessary, so stimulation parameters can be adjusted to individual needs. There may however be trade-offs in programming the stimulator, as the site of optimal motor improvement may cause adverse cognitive or mood side-effects, while a site that does not may also not provide optimal motor control. It is therefore of paramount importance that the DBS device is in an optimal location. Leads should be implanted into the sensori-motor territories of the target nuclei (e.g. sensori-motor STN, GPi, thalamus), and care should be taken not to place the lead too close to surrounding anatomy that may result in current spread and side-effects. Leads placed in the nuclei, but causing current spread into limbic and associative regions, may cause further adverse mood and cognitive effects. Teams implanting and programming DBS devices should monitor the short- and long-term motor, mood, cognitive, and behavioural consequences.
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