Deep Brain Stimulation: A New Era in Functional Neuroscience?

Deep Brain Stimulation (DBS) evolved from functional stereotactic neurosurgery techniques designed to produce selective lesions of the thalamus and cerebellum [1]. In 1952, Irving S. Cooper discovered the potential of ligation therapy when he unintentionally occluded the anterior choroidal artery, causing a medial globuspallidal infarction, which, surprisingly, alleviated rest tremor, rigidity and contralateral cogwheeling. Throughout the 1950s and 1960s, techniques for ablative procedures were refined with much focus on identifying the ideal targets. The motor thalamus and globuspallidusinternus (GPi) were considered the most effective targets [2,3]. In the 1960s, L-dopa became the standard of care for Parkinson's disease (PD) and the popularity of ablative surgeries significantly decreased. During this time, ablative surgeries were primarily limited to thalamotomy to treat tremor and pallidotomy and thalamotomy for dystonia; they were rarely done to treat PD. However, by the 1980s, the limitations (motor fluctuations and dyskinesias) of L-dopa became apparent and ablative surgeries for PD regained popularity [1,3]. Building on the experience of ablative surgeries, stimulation procedures started to become commonplace in the management of movement disorders by the 1990s. This introduced a new era in functional neuroscience for movement disorders.