Symposium on neurosciencesNeurostimulation Devices for the Treatment of Neurologic Disorders
Section snippets
Historical Perspective
The earliest history of what became neuromodulation therapy started with ablative procedures in stereotactic and functional neurosurgery in the mid-20th century to treat neuropsychiatric disorders. At that time, without pharmaceutical options for psychiatric disorders, desperate measures were taken to mitigate debilitating symptoms. The American neurophysiologist John Farquhar Fulton observed that modulation of regions of the cerebral cortex affected behavior in nonhuman primate studies.1 These
Historical Perspective
Another fortuitous discovery in neurosurgery came in the early 1990s, when Tsubokawa hypothesized that stimulation of the somatosensory cortex could alleviate central pain and implanted cortical electrodes into patients with central pain syndromes. To his surprise, these electrodes covering the sensory cortex did not alleviate pain, but at times worsened it. Serendipitously, the stimulating electrodes just anterior to the somatosensory cortex, on the primary motor cortex, inhibited pain.72, 73
Historical Perspective
Epilepsy is a common neurologic disorder that results in regular occurring seizures, which may be broadly categorized as partial or generalized, and manifest in various ways, such as a person having a blank stare for a couple of seconds to incapacitating convulsions and loss of consciousness. Approximately 1% to 2% of the US population has experienced epileptic seizures, with nearly 30% of those patients having treatment-refractory seizures that are unresponsive to antiepileptic drugs.75 In
Historical Perspective
In 1965, Ronald Melzack and Patrick Wall proposed the gate control theory of pain to describe the complex interaction between the central and peripheral nervous systems to process pain and haptic signals. The dorsal horn is thought of as the gate of the spinal cord, in which peripheral nerve fibers carrying pain signals are blocked from ascending the central nervous system, when nerve fibers carrying touch, pressure, or vibration signals are activated. During that time, DBS targets to treat
Historical Perspective
The first publications on VNS were in 1990, and then in 1997 the US FDA's neurologic devices panel met to consider approval of the Cyberonics (now LivaNova) VNS device for the treatment of epilepsy.96 The device consists of a pulse generator that is implanted under the skin below the patient's clavicle and lead wires that are tunneled up to the patient's neck and wrapped around the left vagus nerve at the carotid sheath. In addition, VNS has been used as a therapy for treatment-resistant
Enabling Technologies Evolving Neurostimulation Therapies
To date, the therapeutic mechanisms underlying neurostimulation therapies are not well understood; even so, such approaches are the only effective treatment option for several refractory neurologic disorders and are rapidly expanding to other clinical application domains. Decades of advances in neural activity monitoring technologies have resulted in powerful investigative and clinical tools that are providing remarkable noninvasive, in vivo, multimodal views of the brain. In 2013, the US White
Conclusion
As outlined, the rapid advancements in neurostimulation technologies are providing the necessary tools to treat patients living with many debilitating neurologic and psychiatric disorders. Here, we discussed the established invasive electrical stimulation systems used clinically to induce therapeutic neuromodulation of dysfunctional neural circuitry. Although we are on an accelerated path toward an adaptable and precise neuromodulation therapy, much remains to be accomplished. This includes
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