Targets for Electrical Stimulation in Functional Neurosurgery

Abstract

In 1964, Sheally applied for the first time chronic electrical stimulation of the spinal cord in patients with neuropathic pain. The idea was to activate fibers traveling in the dorsal columns, that would interfere with nociceptive impulses at the level of the spinal cord entrance zone of dorsal roots. He used an internalized battery powered pulse generator similar to the cardiac pacemakers, connected to an epidural electrode. In 1973, Cooper presented before neuroscience meeting audience, cases of children with cerebral palsy that were treated with electrical stimulation of paravermian cerebellar cortex and improved in both: seizure control and spasticity. In 1989, Benabid et al. reported parkinsonian tremor control by chronic electrical stimulation of Vim thalamic nucleus, based in intraoperative experience that high frequency stimulation prior electro coagulation of that target, arrested contralateral tremor [1]. In 1999, Nuttin et al. presented cases of obsessive compulsive disorder (OCD), successfully treated by electrical stimulation (ES) of the anterior branch of the internal capsule [13]. These pioneer observations opened the field of ES of nervous structures in the treatment of chronic neurological disorders that is nowadays one of the most rapidly developing fields in medicine. Indications and targets have rapidly multiplied and most of them represent hypothesis based on animal experiments, extrapolated to clinical cases. Indications for ES include bladder and diaphragm control, vascular peripheral insufficiency and vascular headache among others.