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Future of brain stimulation: New targets, new indications, new technology

Authors


  • Relevant conflicts of interest/financial disclosures: Marwan Hariz, Ludvic Zrinzo, and the Unit of Functional Neurosurgery at the UCL Institute of Neurology are supported by the Parkinson Appeal UK and the Monument Trust. Patric Blomstedt is supported by the Swedish Research Council, the Foundation for Clinical Neuroscience at the University Hospital of Umeå, and the University of Umeå. Marwan Hariz and Ludvic Zrinzo have received travel expenses and honoraria from Medtronic and St Jude Medical for speaking at meetings.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

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

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