Irving S. Cooper and His Role in Intracranial Stimulation for Movement Disorders and Epilepsy

Abstract

Dr. Irving Cooper (1922–1985) was a pioneer in the field of functional neurosurgery. After years of treating patients with tremor by creating deep lesions with either anterior choroidal artery ligation or cryogenic thalamotomy, he began to utilize methods of electrical cerebral stimulation as treatment for a variety of disorders. Chronic cerebellar stimulation was employed for patients with epilepsy, cerebral palsy, and dystonia. While Dr. Cooper believed his results to be significant, there still remain many challenges to his claims. Later in his career, he placed deep brain electrodes in the internal capsule and thalamus for epilepsy and dystonia. His encouraging results from this small series were often overlooked. This paper reviews the science behind Dr. Cooper’s work, his case series, and the controversies surrounding his results.

Deep brain stimulation between 1947 and 1987: the untold story

“…One of the early DBS targets was the anterior nucleus of the thalamus, 22,82,104 the very same target that has reemerged recently and shown benefit in a multicenter blinded randomized controlled trial of DBS for epilepsy. 36 According to Rosenow et al, 82 Cooper had implanted DBS electrodes in the anterior nucleus of the thalamus in patients with refractory complex partial seizures as early as 1979. Of the 6 initial patients, 5 showed a more than 60% reduction of seizure frequency with stimulation at 3.5 V and 60-70 Hz.…”

“…Of the 6 initial patients, 5 showed a more than 60% reduction of seizure frequency with stimulation at 3.5 V and 60-70 Hz. 82 Velasco et al 108 published in 1987 their results of DBS for epilepsy targeting the center median thalamic nucleus. These documented historical facts challenge contemporary statements about DBS being "a new approach" to the treatment of epilepsy.…”

The Development of Deep Brain Stimulation for Movement Disorders

“…The first recorded instance of electrical impulses being applied to the living brain appears to be in the 1800s and cats were the subjects [46]. Over the years, various animal species were used to demonstrate that when electrical current is applied to the brain, movement as well as other actions could be produced or inhibited.…”

“…When the patient awoke from anesthesia, his tremor was almost completely gone as was the rigidity but his strength remained intact. Cooper reported on eight cases with similar results [106] but eventually abandoned the operation secondary to variability in the distribution of the artery [46].…”

The History and Future of Deep Brain Stimulation

“…27 Concurrently, other groups were working on DBS for the persistent vegetative state, 28 -30 and Irving Cooper was placing electrodes over the cerebellum and into the deep thalamic nuclei for cerebral palsy, spasticity, and epilepsy. 31 Cooper reported his results from chronic cerebellar stimulation in over 200 patients in 1977 (reviewed in reference 30). Although these results were excellent, there was significant concern about whether the improvements were meaningful, as well as the subjective nature of his rating scales.…”