Current and Emerging Surgical Treatments
History of Neurosurgery with Movement Disorders
Challenges with Specific Mention of Contributions of Neurosurgeons (Neuromodulation)
Early Investigations in Neurostimulation
Electrical Stimulation was described as early as 15 AD when Scribonius used an electric torpedo fish for gout pain treatment . In the 1770's both Benjamin Franklin  and Galvani  noted electrical stimulation caused muscle contraction. One hundred years later, cortical stimulation was described first in an animal , and in an awake patient with exposed motor cortex after debridement for osteomyelitis . Intraoperative stimulation was described in 1884 by Sir Victor Horsley . Spiegel and Wycis used electrical stimulation in stereotactic procedures in the 1940's, however it was Hassler who first suggested the possiblitity of long term effects of stimulation .
Permanent Stimulator Implants for Movement Disorders
In 1980 the term permanently implanted thalamic Deep Brain Stimulators (DBS) were reported by Cooper , Brice and McLellan's , and Benabid's groups . Next DBS of the pallidum was described by Siegfried and Lippitz  and STN DBS was reported .Dystonia was treated beginning in the 1990's with pallidal stimulation in both cervical dystonia  and generalized dystonia [14, 15]. The Food and Drug Administration (FDA) in the United States approved thalamic DBS for Essential tremor, STN and pallidal DBS for Parkinson's Disease, and pallidal DBS for Dystonia 1997, 2002, and 2003 respectively.
Alternative Technical Approaches
New technologies in DBS placement include frameless neuronavigation , presurgical fabrication of an insertion platform designed to aim to the desired target, customized to the individual patients' anatomy (STarFix, FHC, Bowdoin, ME) , and placement of the lead using real-time high-field interventional MRI. The frameless neuronavigation and STarFix approaches allow the stereotactic imaging to be performed days before the surgery, which may improve efficiency on the day of surgery. Both require the implantation of bone-mounted fiducial markers. Pilot studies investigating the interventional MRI approach have been especially useful for patients unable to tolerate awake surgery for the DBS case .
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