Deep Brain Stimulation effectiveness

 From practice.com and sciencedirect.com.

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Abstract

Deep brain stimulation (DBS) surgery is an established and effective treatment for several movement disorders (tremor, Parkinson's disease, and dystonia), and is under investigation in numerous other neurological and psychiatric disorders. However, the origins and development of this neurofunctional technique are not always well understood and recognized. In this mini-review, we review the history of DBS, highlighting important milestones and the most remarkable protagonists (neurosurgeons, neurologists, and neurophysiologists) who pioneered and fostered this therapy throughout the 20th and early 21st century. Alongside DBS historical markers, we also briefly discuss newer developments in the field, and the future challenges which accompany such progress.

Introduction

“If you want to understand today you have to search yesterday” (Pearl S. Buck)

Deep brain stimulation (DBS) is a neurosurgical technique which has gained global recognition for its effectiveness in treating several neurological and non-neurological disorders [1]. However, it is in the field of movement disorders where DBS has flourished most. Building on previous experience of surgical lesioning approaches and an improved understanding of the effects of high-frequency stimulation on various abnormal movements, DBS first proved its efficacy in the treatment of tremor in the late 1980s [2]. In the early 1990s, a major breakthrough in the management of patients with advanced Parkinson's disease (PD) occurred with the publication of the first cases of subthalamic nucleus (STN) DBS by the Grenoble team, led by Benabid and Pollak [3]. The clical benefit of STN DBS was so remarkable that, watching the videos of these ‘resurrected’ parkinonian patients, David Marsden stated that “[STN DBS is] … the most important discovery since levodopa” [4]. In subsequent decades, the use of DBS expanded to the management of other movement disorders such as dystonia and Tourette's syndrome, as well as epilepsy, headache, and some psychiatric disorders. To date, about 200,000 patients worldwide have received DBS for movement disorders. Several other indications are still under study, like depression, addiction, obsessive-compulsive disorder, dementia, vegetative states, aggressiveness, and post-traumatic stress disorder.

In this mini-review celebrating the 30th anniversary of STN DBS surgery, we highlight the most important historical milestones and the protagonists whose pioneering work throughout the 20th century elevated DBS surgery to the level of a mainstream treatment for movement disorders (see Fig. 1). We also review the main advances made in the field of DBS in the last 3 decades, particularly as they relate to movement disorders, and discuss future challenges which accompany such developments.

Section snippets

Stereotaxis and the dawn of precise sub-cortical localisation

At the turn of the 20th century, psychosurgery was in vogue for management of various mental ailments. Side-effects resulting from imprecise lesion targeting however remained a problem, which drove physicians to seek more accurate methods of sub-cortical localisation. Such an instrument, enabling accurate intracranial localisation based on 3D cartesian coordinates (which the authors termed ‘stereotaxis’), had conveniently been developed in 1908 by Horsely and Clarke [5]. Unfortunately, their
Advaces in surgical and operative procedures

Approaches to precise localisation of sub-cortical targets have been refined over the years since DBS inception. Initially, ‘indirect targeting’, meaning locating a structure based on pre-defined anatomic coordinates relative to the midcommissural point (MCP) of the anterior commissure–posterior commissure (AC-PC) line- originally defined using ventriculography- was used, and lead trajectories confirmed using plain X-rays. Later, developments in brain CT and MRI enabled transition to ‘direct

Conclusion

The year 2023 has marked the 30th anniversary of STN DBS for PD. However, as recounted, to regard this remarkable story as one spanning only the last three decades would be naïve. Though Benabid & Pollak deserve much credit for rejuvenating, popularising and driving the expansion of DBS, their work built upon half a century of toil by oft un-sung heroes, who through courageous experimentation and dogged determination helped shape our understanding of therapeutic high frequency neurostimulation.