Historical Considerations

The modern history of electrical stimulation of the brain dates to the nineteenth century During this period the French surgeon and anthropologist Paul Broca (1824—1880) correlated speech with an area in the left hemisphere that is known as Broca's area, and the English neurologist John Hughlings Jackson hypothesized that electrical activity in the cortex could result in seizures. In tandem with these efforts to correlate cerebral structure and function, early neurophysiologists engaged in animal experimentation using electrical stimulation In 1870 the German neurologists Eduard Hitzig and Gustav Fritsch demonstrated motor activity in a dog following stimulation (Thomas and Young). In 1873 the Scottish neurologist David Ferrier induced contralateral seizures in a dog after unilateral hemispheric stimulation.

The first known electrical stimulation of the human brain was conducted by the American neurosurgeon Roberts Bartholow in Cincinnati, Ohio, in 1874 on a terminally ill woman with locally invasive basal cell carcinoma that had eroded her skull and left her brain exposed. Bartholow demonstrated that the dura mater covering the brain was insensate, that motor activity on one side of the body could be induced by stimulation of the opposite hemisphere, and that electrical stimulation of the brain could induce localized seizures and transient loss of consciousness when the amount of current was increased. The patient subsequently died from recurrent seizure activity. Contemporaries harshly criticized Bartholow on ethical grounds because of the fatal complications of the intervention, the uncertain nature of the patient's "consent," and the suffering that she experienced (Morgan).

Early electrical stimulation of the brain was used as a method of mapping cerebral cortical function, matching the site of stimulation of the brain's surface with the patient's response during operations under local anesthesia. Pioneering work was done by two American neurosurgeons: Harvey Cushing in the early twentieth century and Wilder Penfield, who later in the century used electrical stimulation in his study of epilepsy and the mapping of cognitive function. An important advance was the development in 1947 ofstereotactic surgery, which enabled brain targets to be precisely located in three dimensions. With this technique, electrodes could now be inserted in the brain without the completion of a full craniotomy in which the entire skull needs to be opened (Gildenberg, 1990).

Robert G. Heath first described electrical stimulation for the control of chronic pain in his 1954 book, Studies in Schizophrenia. In the 1960s and 70s investigators demonstrated that deep stimulation of selected targets within the brain was demonstrated to relieve pain In 1985, the Swiss neurosurgeon, Jean Siegfried noted that stimulation of the thalamus for pain control could improve tremor in a patient with Parkinson's disease (Gildenberg, 1998).

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