Epidural Cortical Stimulation

The focus of this chapter is the development of epidural cortical stimulation (ECS) as a potential treatment for neuropsychiatric disease, especially treatment-resistant depression (TRD). TRD patients have long-lasting depressive episodes, are prone to frequent relapses, and have limited treatment options. The chapter discusses the functional neurosurgical alternative to deep brain stimulation (DBS) with epidural lead placements and suggests that it may be a safer mode of accessing mood regulating networks, although to date, such experience is still very limited. Two regions of the prefrontal cortex are prime candidates for cortical brain stimulation to treat depression through modulation of local and subcortical activity: frontopolar region and mid-lateral frontal regions. Emotion regulation involves the ability to modulate the intensity and quality of responses to emotional stimuli, involving both automatic and controlled regulatory processes. Mentalization recruits several complementary limbic, attention and high-level executive networks including the frontopolar cortex.