Introduction

Gillingham, Paul

doi:10.12987/yale/9780300253122.003.0001

Cited by 1 publication

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“…Pioneers in the field, starting with Spiegel and Wycis and onward, placed their lesions at various strategic nodes along these networks: pallido-ansotomy, campotomy (campus forelli), subthalamotomy (avoiding the STN), ventrolateral thalamotomy (including Vim, Vop, Voa). John Gillingham wrote about stereotactic surgery on "the basal ganglia, and the tracts and nuclei of the brain stem" describing "the destruction of cell stations or interruption of fiber connections," and illustrated beautifully this circuitry in his publication from 1966 [55], as well as in his paper introducing the "Third Symposium on Parkinson's Disease" held in Edinburgh in May 1968, with a drawing outlining "a pathway within the basal ganglia and capsule, the adequate interruption of which at any site relieves tremor and rigidity and some of the other symptoms of Parkinsonism" [56].…”

Section: Brain Circuitries and Targetingmentioning

confidence: 98%

Thirty Years of Global Deep Brain Stimulation: “Plus ça change, plus c’est la même chose”?

Hariz,

Cif,

Blomstedt

2023

Stereotact Funct Neurosurg

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Background: The advent of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease 30 years ago has ushered a global breakthrough of DBS as a universal method for therapy and research in wide areas of neurology and psychiatry. The literature of the last three decades has described numerous concepts and practices of DBS, often branded as novelties or discoveries. However, reading the contemporary publications often elicits a sense of déjà vu in relation to several methods, attributes, and practices of DBS. Here, we review various applications and techniques of the modern-era DBS and compare them with practices of the past. Summary: Compared with modern literature, publications of the old-era functional stereotactic neurosurgery, including old-era DBS, show that from the very beginning multidisciplinarity and teamwork were often prevalent and insisted upon, ethical concerns were recognized, brain circuitries and rational for brain targets were discussed, surgical indications were similar, closed-loop stimulation was attempted, evaluations of surgical results were debated, and controversies were common. Thus, it appears that virtually everything done today in the field of DBS bears resemblance to old-time practices, or has been done before, albeit with partly other tools and techniques. Movement disorders remain the main indications for modern DBS as was the case for lesional surgery and old-era DBS. The novelties today consist of the STN as the dominant target for DBS, the tremendous advances in computerized brain imaging, the sophistication and versatility of implantable DBS hardware, and the large potential for research. Key Messages: Many aspects of contemporary DBS bear strong resemblance to practices of the past. The dominant clinical indications remain movement disorders with virtually the same brain targets as in the past, with one exception: the STN. Other novel brain targets – that are so far subject to DBS trials – are the pedunculopontine nucleus for gait freezing, the anteromedial internal pallidum for Gilles de la Tourette and the fornix for Alzheimer’s disease. The major innovations and novelties compared to the past concern mainly the unmatched level of research activity, its high degree of sponsorship, and the outstanding advances in technology that have enabled multimodal brain imaging and the miniaturization, versatility, and sophistication of implantable hardware. The greatest benefit for patients today, compared to the past, is the higher level of precision and safety of DBS, and of all functional stereotactic neurosurgery.

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Section: Brain Circuitries and Targetingmentioning

confidence: 98%