The clinical utility of methods to determine spatial extent and volume of tissue activated by deep brain stimulation

摘要

Electrical stimulation of the nervous system is a burgeoning therapeutic technology, already in routine use for a range of neurological and psychiatric conditions, including movement disorders, epilepsy, pain, depression, and others (Gross, 2004). Its various incarnations, all undergoing continual development and refinement, comprise direct and indirect cortical stimulation, spinal cord stimulation, peripheral and cranial nerve stimulation, and deep brain stimulation (DBS) of diverse targets. Yet, despite pervasive use and a long history (Dioscorides is said to'have used the electric ray to treat epilepsy in 76 AD (Kellaway, 1946)), the biophysical and physiological effects of electrical stimulation on the nervous system remain poorly understood. This detailed mechanistic knowledge, once gained, promises to free us from exhaustive and ad hoc investigations of stimulation parameters and targets, and rather provides us with optimal stimulation protocols, rationally selected for each disorder and each patient.