Deep brain stimulation: current practice and challenges for the future

Chronic Deep Brain Stimulation (DBS), which was approved for the treatment of symptoms in Parkinson Disease in 1998, is a conceptually new tool in the field of Neuromodulation. DBS is fundamentally similar to most pharmacological neuro modulation therapies: Both modulate synaptic transmission between nerve cells by modulating the release and/or effectivity of neurotransmitters in synapses. The highly specific functional modulation of brain structures in DBS opens new avenues for Neuromodulation in e.g. epilepsy and psychiatric diseases. Clinical application of DBS (Activa /spl reg/ Therapy), although in the large majority of the patients clinically highly effective, shows a wide range of outcomes. Maturation and standardization of the DBS therapy are required to bring DBS up to "standard of medical care". This paper will address the main concepts of the DBS therapy: Neuroanatomical stereotactic imaging and neurphysio logical brain target identification as well as further research and development to bring this therapy up to standard of medical care.