Brain stimulation: history, current clinical application, and future prospects
The dramatic effects of chronic brain stimulation in the treatment of movement disorders have spurred a renewed interest in this technique for treating a variety of other conditions. This technique has only recently begun to reach its vast clinical potent
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Brain stimulation: history, current clinical application, and future prospects A. Y. Mogilner 1 and A. R. Rezai 2 1 2
Department of Neurosurgery, New York Medical College, Valhalla, New York, U.S.A. Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
Summary The dramatic effects of chronic brain stimulation in the treatment of movement disorders have spurred a renewed interest in this technique for treating a variety of other conditions. This technique has only recently begun to reach its vast clinical potential, due to a number of significant advances in basic and clinical neurosciences. Current image-guided navigation systems and intraoperative physiological mapping techniques offer more efficient, consistent, and precise targeting. Advances in neurophysiology have helped elucidate the pathophysiology of a number of disease states and thus provided for rational target selection for therapy. The latest generation of stimulation equipment allows for precise tailoring of stimulation parameters to maximize clinical benefit. These techniques are now being applied to a variety of other conditions including chronic pain, epilepsy, and psychiatric disorders. Keywords: Brain stimulation; movement disorders; chronic pain.
Historical overview In 1948, J. L. Pool of Columbia University placed a silver electrode, via open craniotomy, into the caudate nucleus of a woman with severe depression secondary to advanced Parkinson's disease, and connected it to an implanted induction coil [50]. Stimulation performed over a period of eight weeks improved her mood a nd her appetite. Chronic stimulation of a number of subcortical targets was used throughout the next decade to treat both psychiatric disorders and chronic pain [24]. Stereotactic neurosurgery, introduced by Spiegel and Wycis in 1947 [59], provided a less invasive and precise method of placing electrodes into the brain, and the vast majority of these procedures were performed stereotactically. Interestingly, movement disorder surgery was one of the few areas where chronic stimulation was not considered a treatment option, due to the excellent clinical results obtained by subcortical lesioning procedures such as thalamotomy and pallidotomy. However, as
stimulation was routinely used prior to creation of a permanent lesion in order to predict its clinical efficacy, the effects of stimulation on various movement disorders were well known. Spiegel and Wycis reported that low frequency stimulation of the globus pallidus could elicit or augment tremor [58], while Hassler noted that higher frequency stimulation could reduce or even arrest tremor [21, 23]. With the advent of levodopa in the 1960s, the use of stereotactic surgery for movement disorders dramatically declined. During the next two decades, the primary use of brain stimulation was for the treatment of refractory pain, with mixed results. With the introduction, by Benabid et al. [6] in 1987, of thalamic stimulation for tremor control, a renaissance in the use of brain stimulation was begun.
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