History Repeats Itself

Gildenberg, Philip L.

doi:10.1159/000075162

Cited by 28 publications

(11 citation statements)

References 52 publications

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“…Stereotactic ablative surgeries targeting the globus pallidus internal segment (GPi), the ventral intermediate thalamic nucleus, and the subthalamic nucleus (STN) have been a major tool for treating the symptoms of Parkinson's disease (PD) and other movement disorders for over 50 years (Gildenberg, 2003). Since the early days of ablation surgeries, electrical stimulation of these nuclei has been used to localize the target, leading to the observation that stimulation reduces tremor in patients.…”

Section: Introductionmentioning

confidence: 99%

Complex Locking Rather Than Complete Cessation of Neuronal Activity in the Globus Pallidus of a 1-Methyl-4-Phenyl-1,2,3,6-Tetrahydropyridine-Treated Primate in Response to Pallidal Microstimulation

Bar‐Gad

Elias²,

Vaadia³

et al. 2004

J. Neurosci.

143

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High-frequency stimulation of the globus pallidus (GP) has emerged as a successful tool for treating Parkinson's disease and other motor disorders. However, the mechanism governing its therapeutic effect is still under debate. To shed light on the basic mechanism of deep brain stimulation (DBS), we performed microstimulation in the GP of a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated monkey while recording with other microelectrodes in the same nucleus. We used robust methods to reduce the stimulus artifact, and 600 -3000 repetitions of a single stimulus and of high-frequency short trains (10 -40 stimuli), enabling high temporal resolution analysis of neural responses. Low-frequency stimulation yielded a typical three-stage response: short-term (2-3 msec duration) activity, followed by mid-term (15-25 msec) inhibition, and occasionally longer-term (30 -40 msec) excitation. Trains of high-frequency stimuli elicited complex locking of the response to the stimuli in most neurons. The locking displayed a stereotypic temporal structure consisting of three short-duration (1-2 msec) phases: an initial (mean latency ϭ 2.9 msec) excitation followed by an inhibition (4.6 msec) and a second excitation (6.3 msec). The change in the mean firing rate was mixed; the majority of the neurons displayed partial inhibition during the stimulus train. Slow inhibitory and excitatory multiphase changes in the firing rate were observed after the stimulus trains. The activity of neurons recorded simultaneously displayed rate correlations but no spike-to-spike correlations. Our results suggest that the effect of DBS on the GP is not complete inhibition but rather a complex reshaping of the temporal structure of the neuronal activity within that nucleus.

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Section: Introductionmentioning

confidence: 99%

Complex Locking Rather Than Complete Cessation of Neuronal Activity in the Globus Pallidus of a 1-Methyl-4-Phenyl-1,2,3,6-Tetrahydropyridine-Treated Primate in Response to Pallidal Microstimulation

Bar‐Gad

Elias²,

Vaadia³

et al. 2004

J. Neurosci.

143

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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%

Deep brain stimulation between 1947 and 1987: the untold story

Hariz

Blomstedt

Zrinzo

2010

FOC

194

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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“…However, stereotactic neurosurgery demands high accuracy during the procedure for reaching the target point in the intracranial space. The first attempts to create minimally invasive neurosurgery were made during the late 1940s and the early 1950s [1] with the development of stereotactic neurosurgery. In the early stage of stereotactic neurosurgery the imaging of the intracranial space was the most limiting factor.…”

Section: Introductionmentioning

confidence: 99%

Robotic Application in Neurosurgery Using Intelligent Visual and Haptic Interaction

Jerbić¹,

Nikolić²,

Chudy³

2015

Int. j. simul. model.

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Today, the complexity and high technical requirements of neurosurgical operations are so demanding that modern robotic achievements and advances of accompanied technologies appear as the immanent means, which can significantly improve neurosurgical practice. A novel robotic system (RONNARObotic NeuroNAvigation) for application in neurosurgery is presented. The RONNA consists of two conventional articulated robot arms with a total of 13 degrees of freedom. A rigid and accurate robot is used for precise targeting of planned operating points and a compliant robot is used as operative assistant. A distinctive marker was developed for the purpose of precise localization and registration of the patient's head. A novel visual calibration method is presented. The developed dual arm neurosurgical system enables flexible and reliable application with embedded behaviour based control providing intuitive interaction with surgical team and new possibilities compared to the existing surgical robot solutions.

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History Repeats Itself

Cited by 28 publications

References 52 publications

Complex Locking Rather Than Complete Cessation of Neuronal Activity in the Globus Pallidus of a 1-Methyl-4-Phenyl-1,2,3,6-Tetrahydropyridine-Treated Primate in Response to Pallidal Microstimulation

Complex Locking Rather Than Complete Cessation of Neuronal Activity in the Globus Pallidus of a 1-Methyl-4-Phenyl-1,2,3,6-Tetrahydropyridine-Treated Primate in Response to Pallidal Microstimulation

Deep brain stimulation between 1947 and 1987: the untold story

Robotic Application in Neurosurgery Using Intelligent Visual and Haptic Interaction

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