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Functional neurosurgery for movement disorders: a historical perspective.

Alim Louis Benabid¹, Stephan Chabardes, Napoleon Torres

¹CEA Minatec LETI and INSERM, Joseph Fourier University, Grenoble, France. alimlouis@aol.com

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|August 8, 2009

Summary

Deep brain stimulation (DBS) has evolved from pain management to treating movement disorders and psychiatric conditions. Recent advancements in hardware and techniques are expanding DBS applications, including neuroprosthetics and deficit compensation.

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Area of Science:

Neurosurgery
Neuromodulation
Biomedical Engineering

Background:

Deep brain stimulation (DBS) and spinal cord stimulation (SCS) have been used since the 1960s for intractable pain.
Functional neurosurgery for movement disorders declined with levodopa but revived with high-frequency stimulation (HFS) in 1987.
HFS mimics lesions, offering adaptable and reversible treatment for tremors via thalamic stimulation.

Observation:

High-frequency stimulation of the subthalamic nucleus (STN) significantly improved dopaminergic symptoms in Parkinson's disease.
HFS applications expanded to epilepsy, psychiatric disorders (OCD, tics, depression), cluster headaches, obesity, and drug addiction.
STN stimulation is less effective for non-dopaminergic symptoms like freezing of gait.

Findings:

Low-frequency stimulation (25 Hz) of the pedunculopontine nucleus (PPN) improved walking and stability in parkinsonian monkeys.
Simultaneous stimulation of multiple targets or electrodes enhances efficiency.
New hardware, including multi-channel IPGs and rechargeable batteries, facilitates advanced DBS.

Implications:

Nanotechnology enables novel DBS systems for inhibiting/exciting brain structures.
Future DBS may incorporate cortical activity recording for brain-computer interfaces.
Compensation of neurological deficits will become a key area in functional neurosurgery.