The present indication and future of deep brain stimulation

Abstract

The use of electrical stimulation to treat pain in human disease dates back to ancient Rome or Greece. Modern deep brain stimulation (DBS) was initially applied for pain treatment in the 1960s, and was later used to treat movement disorders in the 1990s. After recognition of DBS as a therapy for central nervous system (CNS) circuit disorders, DBS use showed drastic increase in terms of adaptability to disease and the patient's population. More than 100,000 patients have received DBS therapy worldwide. The established indications for DBS are Parkinson's disease, tremor, and dystonia, whereas global indications of DBS expanded to other neuronal diseases or disorders such as neuropathic pain, epilepsy, and tinnitus. DBS is also experimentally used to manage cognitive disorders and psychiatric diseases such as major depression, obsessive-compulsive disorder (OCD), Tourette's syndrome, and eating disorders. The importance of ethics and conflicts surrounding the regulation and freedom of choice associated with the application of DBS therapy for new diseases or disorders is increasing. These debates are centered on the use of DBS to treat new diseases and disorders as well as its potential to enhance ability in normal healthy individuals. Here we present three issues that need to be addressed in the future: (1) elucidation of the mechanisms of DBS, (2) development of new DBS methods, and (3) miniaturization of the DBS system. With the use of DBS, functional neurosurgery entered into the new era that man can manage and control the brain circuit to treat intractable neuronal diseases and disorders.

Fig. 1

Two technologies of DBS under development. A: Closed loop DBS system with a sensor in the apparatus, and a stimulator, which is activated only when the sensor detects abnormal brain signals. B: Multidirectional DBS leads where three or four electrodes surround around the lead axis. One can select not only the depth but also the direction of each current flow. DBS: deep brain stimulation.

Fig. 2

Neuroendoscopic deep brain stimulation. In this method, electrodes will be placed on the ventricular wall using a neuroendoscope. There are multiple areas surrounding the ventricular wall, which are already used as the target of functional neurosurgery, or which could be used for functional stimulation.