Abstract
 

75 yrs of deep brain stimulation: from treatment to enhancement?

The first evidence of a case of a patient treated with deep brain stimulation (DBS) dates back to the year 1948. The patient suffered from anorexia and depression. In that time area, surgery was the only treatment option for patients suffering from psychiatric disorders, with amongst others, lobectomies that were performed on a large scale. The stereotactic technique has been developed in 1947 by Spiegel and Wycis as a reaction to the high complication rate of these lobectomies. However, due to some malpractices with DBS for psychiatric disorders, DBS came in a taboo atmosphere.
In 1987, A.L. Benabid, a neurosurgeon in Grenoble, performed DBS in a patient suffering from essential tremor. Since then, about 300.000 cases worldwide have been treated with DBS, mainly for movement disorders.

In our department, DBS related research focusses on optimizing the technque of DBS on one hand, and exploring new indications, on the other.
Optimising the technique means, increasing precision and accuracy, this latter meaning, finding the patient’s most optimal stimulation point. Here, individualized targeting based on connectomics is an important step. Connectomics can not only be used for optimal targeting for DBS, but also for fMRI based neurofeedback. This is performed as part of a large multicenter trial (‘Neuripides’), with the University of Maastricht being the PI-center.

Another goal is to develop closed loop stimulation or, on demand, or adaptive stimulation (aDBS) thus only stimulating when needed. A first step here is to define biomarkers. These are well know for Parkinson Disease. In our studies, we aim at defining biomarkers for aDBS for Tourette syndrome and essential tremor.

Last but not least, DBS for Alzheimer’s dementia (AD) is an important research topic of our team, not only what animal research, but also clinical studies is concerned. We focus on two targets: the fornix on one hand, and the nucleus basalis Meynert, on the other. With a transgenic rat model for AD, we investigate different stimulation paradigms in our lab.
The role of the fornix as a potential target for DBS in AD is found by coincidence, by Andres Lozano in Toronto. The first effects of fornix DBS on memory were shown in a patient with a normal cognitive function, and illustrate that enhancing memory in healty people is possible. In epilepsy patients, stimulation of the hippocampus has been shown to even so being able to enhance memory.

The potential evolution in the direction of enhancement is subject to an intense ethical debate worldwide.