Deep brain stimulation

Deep Brain Stimulation (DBS) is a chronic neurosurgical intervention for the treatment of brain disorders. Most notably, DBS is used to treat movement disorders and more recently epilepsy and psychological disorders. The historical roots of DBS therapy stem from ablative procedures in which the removal of key nodal structures within the brain resulted in relief of symptoms, such as reduction in tremor after lesioning the cerebello-thalamocortical pathway. DBS targets these same pathways but uses a high frequency electrical pulse train that can be tuned post-operatively to minimize a patient's symptoms. This chapter explores the current state of the field in terms of the technological components of a DBS system, clinical indications targeted by DBS therapy, and physiological mechanisms underlying effective treatment. Finally, this chapter also explores new directions in the field, such as improving the spatial resolution of DBS for modulating pathways within the brain, leveraging synaptic plasticity in the programming algorithms, and using behavioral and neurophysiological feedback to tailor the therapy to a given patient's symptoms.