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Future of brain stimulation: New targets, new indications, new technology
Author(s) -
Hariz Marwan,
Blomstedt Patric,
Zrinzo Ludvic
Publication year - 2013
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.25665
Subject(s) - deep brain stimulation , dystonia , neuroscience , brain stimulation , neuromodulation , psychology , neuroethics , cognition , movement disorders , psychiatry , parkinson's disease , medicine , disease , stimulation , pathology
In the last quarter of a century, DBS has become an established neurosurgical treatment for Parkinson's disease (PD), dystonia, and tremors. Improved understanding of brain circuitries and their involvement in various neurological and psychiatric illnesses, coupled with the safety of DBS and its exquisite role as a tool for ethical study of the human brain, have unlocked new opportunities for this technology, both for future therapies and in research. Serendipitous discoveries and advances in structural and functional imaging are providing abundant “new” brain targets for an ever‐increasing number of pathologies, leading to investigations of DBS in diverse neurological, psychiatric, behavioral, and cognitive conditions. Trials and “proof of concept” studies of DBS are underway in pain, epilepsy, tinnitus, OCD, depression, and Gilles de la Tourette syndrome, as well as in eating disorders, addiction, cognitive decline, consciousness, and autonomic states. In parallel, ongoing technological development will provide pulse generators with longer battery longevity, segmental electrode designs allowing a current steering, and the possibility to deliver “on‐demand” stimulation based on closed‐loop concepts. The future of brain stimulation is certainly promising, especially for movement disorders—that will remain the main indication for DBS for the foreseeable future—and probably for some psychiatric disorders. However, brain stimulation as a technique may be at risk of gliding down a slippery slope: Some reports indicate a disturbing trend with suggestions that future DBS may be proposed for enhancement of memory in healthy people, or as a tool for “treatment” of “antisocial behavior” and for improving “morality.” © 2013 International Parkinson and Movement Disorder Society