Evolution of Neuromodulation

Gildenberg, Philip L.

doi:10.1159/000086865

Cited by 100 publications

(52 citation statements)

References 123 publications

(64 reference statements)

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“…9,10 DBS in selected brain regions has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders such as Parkinson's disease, tremor, dystonia, obsessive or compulsive disorders, and chronic pain.…”

Section: Introductionmentioning

confidence: 99%

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Nardone

Höller

Leis

et al. 2013

The Journal of Spinal Cord Medicine

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Context: Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain.Objective: To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy. Methods: A MEDLINE search was performed using following terms: "Spinal cord injury", "Neuropathic pain", "Brain stimulation", "Deep brain stimulation" (DBS), "Motor cortex stimulation" (MCS), "Transcranial magnetic stimulation" (TMS), "Transcranial direct current stimulation" (tDCS), "Cranial electrotherapy stimulation" (CES). Results: Invasive neurostimulation therapies, in particular DBS and epidural MCS, have shown promise as treatments for neuropathic and phantom limb pain. However, the long-term efficacy of DBS is low, while MCS has a relatively higher potential with lesser complications that DBS. Among the non-invasive techniques, there is accumulating evidence that repetitive TMS can produce analgesic effects in healthy subjects undergoing laboratory-induced pain and in chronic pain conditions of various etiologies, at least partially and transiently. Another very safe technique of non-invasive brain stimulation -tDCS -applied over the sensorymotor cortex has been reported to decrease pain sensation and increase pain threshold in healthy subjects. CES has also proved to be effective in managing some types of pain, including neuropathic pain in subjects with SCI. Conclusion: A number of studies have begun to use non-invasive neuromodulatory techniques therapeutically to relieve neuropathic pain and phantom phenomena in patients with SCI. However, further studies are warranted to corroborate the early findings and confirm different targets and stimulation paradigms. The utility of these protocols in combination with pharmacological approaches should also be explored.

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Section: Introductionmentioning

confidence: 99%

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Nardone

Höller

Leis

et al. 2013

The Journal of Spinal Cord Medicine

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“…8,9 Intraoperative stimulation along with observations from ablative surgery and animal research advanced our understanding of the STN and other deep brain structures and allowed the production of functional anatomical maps. [10][11][12][13] Implantable neurostimulatory devices were developed in order to produce intermittent DBS in an effort to perform reversible therapy in contrast to irreversible ablation. 14,15 DBS was initially used successfully for cancer pain treatment in the 1950s and 1960s.…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

Role of radiology in central nervous system stimulation

Minks

Pereira²,

Young³

et al. 2015

BJR

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Central nervous system (CNS) stimulation is becoming increasingly prevalent. Deep brain stimulation (DBS) has been proven to be an invaluable treatment for movement disorders and is also useful in many other neurological conditions refractory to medical treatment, such as chronic pain and epilepsy. Neuroimaging plays an important role in operative planning, target localization and post-operative follow-up. The use of imaging in determining the underlying mechanisms of DBS is increasing, and the dependence on imaging is likely to expand as deep brain targeting becomes more refined. This article will address the expanding role of radiology and highlight issues, including MRI safety concerns, that radiologists may encounter when confronted with a patient with CNS stimulation equipment in situ.Central nervous system (CNS) stimulation is becoming increasingly prevalent. Deep brain stimulation (DBS) has been proven to be an invaluable treatment for movement disorders and is also useful in many other neurological conditions refractory to medical treatment, such as chronic pain and epilepsy. Neuroimaging plays an important role in operative planning, target localization and post-operative follow-up. ANATOMY OF THE DEEP BRAIN NUCLEIThe basal ganglia are a complex group of anatomically and neurochemically interconnected structures whose role is the control of complex and intentional movements and to inhibit unwanted movements.1 They comprise the corpus striatum (caudate nucleus, nucleus accumbens and putamen), globus pallidus [external segment (GPe) and internal segment (GPi)], substantia nigra [compact part and reticular part (SNr)] and the subthalamic nucleus (STN) (Figure 1). The pedunculopontine nucleus is highly interconnected with the basal ganglia and is now considered by many to be part of this group. Disorders of the basal ganglia therefore manifest by movement, posture and muscle tone abnormalities.There are wider connections to other parts of the brain such as the thalamus, limbic cortex and prefrontal cortex. These highlight their role in cognition and emotion and explain their implication in some psychiatric disorders and the cognitive symptoms associated with movement disorders.It is these structures and their interconnected neighbours that are the targets for treatment by DBS. The STN is the most common target for DBS treatment because it is capable of treating the entire gamut of advanced Parkinson's disease symptoms, including tremor, rigidity, bradykinesia and drug-induced dyskinesia.2 DBS reduces the need for dopaminergic medication. The benefits are a reduction of motor signs and improvement of functionality in the off-medication phase, a reduction of the required medication dose and its associated complications, and an increased quality of life.3 The benefits usually persist for at least 2 years and can last for many more.The STN plays a key role in the basal ganglia-thalamocortical motor circuit (Figure 2). The striatum receives input from the cerebral cortex and direct pathway information pa...

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“…98 According to Gildenberg, 37,38 who was a fellow of Spiegel and Wycis in the 1950s, intraoperative electrical stimulation was used from the very beginning as a mean of exploring the brain target prior to lesioning. Thus, from its very beginning, functional stereotactic neurosurgery was multidisciplinary, was directed at the treatment of psychiatric illness, and used electrical stimulation as a physiological means of assessing and corroborating the subcortical anatomical brain target.…”

Section: Origins Of Dbsmentioning

confidence: 99%

“…A review of prior stereotactic literature reveals that frequency of the applied current during intraoperative stimulation of the brain target prior to stereotactic lesioning was often a matter of debate with several authors exploring this issue. In his review on evolution of neuromodulation, Gildenberg stated, 37 There was considerable discussion on 'low frequency' versus 'high frequency' stimulation, but those terms were not consistently defined. Low frequency might be anywhere from 6 to 60 Hz.…”

Section: Frequency Of the Electrical Current Used For Stimulationmentioning

confidence: 99%

Deep brain stimulation between 1947 and 1987: the untold story

Hariz

Blomstedt

Zrinzo

2010

FOC

192

120

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Deep brain stimulation (DBS) is the most rapidly expanding field in neurosurgery. Movement disorders are well-established indications for DBS, and a number of other neurological and psychiatric indications are currently being investigated. Numerous contemporary opinions, reviews, and viewpoints on DBS fail to provide a comprehensive account of how this method came into being. Misconceptions in the narrative history of DBS conveyed by the wealth of literature published over the last 2 decades can be summarized as follows: Deep brain stimulation was invented in 1987. The utility of high-frequency stimulation was also discovered in 1987. Lesional surgery preceded DBS. Deep brain stimulation was first used in the treatment of movement disorders and was subsequently used in the treatment of psychiatric and behavioral disorders. Reports of nonmotor effects of subthalamic nucleus DBS prompted its use in psychiatric illness. Early surgical interventions for psychiatric illness failed to adopt a multidisciplinary approach; neurosurgeons often worked “in isolation” from other medical specialists. The involvement of neuro-ethicists and multidisciplinary teams are novel standards introduced in the modern practice of DBS for mental illness that are essential in avoiding the unethical behavior of bygone eras. In this paper, the authors examined each of these messages in the light of literature published since 1947 and formed the following conclusions. Chronic stimulation of subcortical structures was first used in the early 1950s, very soon after the introduction of human stereotaxy. Studies and debate on the stimulation frequency most likely to achieve desirable results and avoid side effects date back to the early days of DBS; several authors advocated the use of “high” frequency, although the exact frequency was not always specified. Ablative surgery and electrical stimulation developed in parallel, practically since the introduction of human stereotactic surgery. The first applications of both ablative surgery and chronic subcortical stimulation were in psychiatry, not in movement disorders. The renaissance of DBS in surgical treatment of psychiatric illness in 1999 had little to do with nonmotor effects of subthalamic nucleus DBS but involved high-frequency stimulation of the very same brain targets previously used in ablative surgery. Pioneers in functional neurosurgery mostly worked in multidisciplinary groups, including when treating psychiatric illness; those “acting in isolation” were not neurosurgeons. Ethical concerns have indeed been addressed in the past, by neurosurgeons and others. Some of the questionable behavior in surgery for psychiatric illness, including the bygone era of DBS, was at the hands of nonneurosurgeons. These practices have been deemed as “dubious and precarious by yesterday's standards.”

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Evolution of Neuromodulation

Cited by 100 publications

References 123 publications

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: A review

Role of radiology in central nervous system stimulation

Deep brain stimulation between 1947 and 1987: the untold story

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