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Electrical brain stimulation (EBS), also referred to as focal brain stimulation (FBS), is a form of electrotherapy used as a technique in research and clinical neurobiology to stimulate a neuron or neural network in the brain through the direct or indirect excitation of its cell membrane by using an electric current. EBS is used for research or for therapeutic purposes.
Electrical brain stimulation was first used in the first half of the 19th century by pioneering researchers such as Luigi Rolando [ citation needed ] (1773–1831) and Pierre Flourens [ citation needed ] (1794–1867), to study the brain localization of function, following the discovery by Italian physician Luigi Galvani (1737–1798) that nerves and muscles were electrically excitable. The stimulation of the surface of the cerebral cortex by using brain stimulation was used to investigate the motor cortex in animals by researchers such as Eduard Hitzig (1838–1907), Gustav Fritsch (1838–1927), David Ferrier (1842–1928) and Friedrich Goltz (1834–1902). The human cortex was also stimulated electrically by neurosurgeons and neurologists such as Robert Bartholow (1831–1904) and Fedor Krause (1857–1937).
In the following century, the technique was improved by the invention of the stereotactic method by British neurosurgeon pioneer Victor Horsley (1857–1916), and by the development of chronic electrode implants by Swiss neurophysiologist Walter Rudolf Hess (1881–1973), José Delgado (1915–2011) and others, by using electrodes manufactured by straight insulated wire that could be inserted deep into the brain of freely-behaving animals, such as cats and monkeys. This approach was used by James Olds (1922–1976) and colleagues to discover brain stimulation reward and the pleasure center. American-Canadian neurosurgeon Wilder Penfield (1891–1976) and colleagues at the Montreal Neurological Institute used extensive electrical stimulation of the brain cortex in awake neurosurgical patients to investigate the motor and sensory homunculus (the representation of the body in the brain cortex according to the distribution of motor and sensory territories).
EBS remains inextricably entwined with the work of Robert Galbraith Heath, Delgado and Penfield. It's of interest that during cerebral localization studies, neurosurgeon Penfield could not elicit emotional reactions in humans, either by observing spontaneous epilepsy or by electrically stimulating the surface of the cerebral cortex. Neurophysiologist Delgado noted a few exceptions to this rule. In contrast, EBS, via deeply implanted electrodes in localized areas of the brain (deep brain stimulation; DBS), elicited both pleasurable and aversive responses in laboratory animals and humans as previously described. [1] [2] [3]
EBS could elicit the ritualistic, motor responses of sham rage in cats by stimulation of the anterior hypothalamus, as well as more complex emotional and behavioral components of "true rage" in both experimental animals by stimulation of the lateral hypothalamus, and in human subjects by stimulating various deep areas of the brain. EBS in human patients with epilepsy could trigger seizures on the surface of the brain and pathologic aggression and rage with stimulation of the amygdala. [3] [4]
Two-photon excitation microscopy has shown that microstimulation activates neurons sparsely around the electrode even at low currents (as low as 10 μA) up to distances as far as four millimeters away. This happens without particularly selecting other neurons much nearer the electrode's tip. This is due to activation of neurons being determined by whether they do or do not have axons or dendrites that pass within a radius of 15 μm near the tip of the electrode. As the current is increased the volume around the tip that activates neuron axons and dendrites increases and with this the number of neurons activated. Activation is most likely to be due to direct depolarization rather than synaptic activation. [5]
A comprehensive review of EBS research compiled a list of many different acute impacts of stimulation depending on the brain region targeted. Following are some examples of the effects documented: [6]
EBS in face-sensitive regions of the fusiform gyrus caused a patient to report that the faces of the people in the room with him had "metamorphosed" and became distorted: "Your nose got saggy, went to the left. [...] Only your face changed, everything else was the same." [7]
Examples of therapeutic EBS are:
Strong electric currents may cause a localized lesion in the nervous tissue, instead of a functional reversible stimulation. This property has been used for neurosurgical procedures in a variety of treatments, such as for Parkinson's disease, focal epilepsy and psychosurgery. Sometimes the same electrode is used to probe the brain for finding defective functions, before passing the lesioning current (electrocoagulation).
An evoked potential or evoked response is an electrical potential in a specific pattern recorded from a specific part of the nervous system, especially the brain, of a human or other animals following presentation of a stimulus such as a light flash or a pure tone. Different types of potentials result from stimuli of different modalities and types. Evoked potential is distinct from spontaneous potentials as detected by electroencephalography (EEG), electromyography (EMG), or other electrophysiologic recording method. Such potentials are useful for electrodiagnosis and monitoring that include detections of disease and drug-related sensory dysfunction and intraoperative monitoring of sensory pathway integrity.
Wilder Graves Penfield was an American-Canadian neurosurgeon. He expanded brain surgery's methods and techniques, including mapping the functions of various regions of the brain such as the cortical homunculus. His scientific contributions on neural stimulation expand across a variety of topics including hallucinations, illusions, dissociation and déjà vu. Penfield devoted much of his thinking to mental processes, including contemplation of whether there was any scientific basis for the existence of the human soul.
The claustrum is a thin sheet of neurons and supporting glial cells, that connects to the cerebral cortex and subcortical regions including the amygdala, hippocampus and thalamus of the brain. It is located between the insular cortex laterally and the putamen medially, encased by the extreme and external capsules respectively. Blood to the claustrum is supplied by the middle cerebral artery. It is considered to be the most densely connected structure in the brain, and thus hypothesized to allow for the integration of various cortical inputs such as vision, sound and touch, into one experience. Other hypotheses suggest that the claustrum plays a role in salience processing, to direct attention towards the most behaviorally relevant stimuli amongst the background noise. The claustrum is difficult to study given the limited number of individuals with claustral lesions and the poor resolution of neuroimaging.
The motor cortex is the region of the cerebral cortex involved in the planning, control, and execution of voluntary movements. The motor cortex is an area of the frontal lobe located in the posterior precentral gyrus immediately anterior to the central sulcus.
The human secondary somatosensory cortex is a region of cortex in the parietal operculum on the ceiling of the lateral sulcus.
Sensory processing is the process that organizes and distinguishes sensation from one's own body and the environment, thus making it possible to use the body effectively within the environment. Specifically, it deals with how the brain processes multiple sensory modality inputs, such as proprioception, vision, auditory system, tactile, olfactory, vestibular system, interoception, and taste into usable functional outputs.
Intraoperative neurophysiological monitoring (IONM) or intraoperative neuromonitoring is the use of electrophysiological methods such as electroencephalography (EEG), electromyography (EMG), and evoked potentials to monitor the functional integrity of certain neural structures during surgery. The purpose of IONM is to reduce the risk to the patient of iatrogenic damage to the nervous system, and/or to provide functional guidance to the surgeon and anesthesiologist.
A cortical homunculus is a distorted representation of the human body, based on a neurological "map" of the areas and proportions of the human brain dedicated to processing motor functions, and/ or sensory functions, for different parts of the body. Nerve fibres—conducting somatosensory information from all over the body—terminate in various areas of the parietal lobe in the cerebral cortex, forming a representational map of the body.
Electrocorticography (ECoG), a type of intracranial electroencephalography (iEEG), is a type of electrophysiological monitoring that uses electrodes placed directly on the exposed surface of the brain to record electrical activity from the cerebral cortex. In contrast, conventional electroencephalography (EEG) electrodes monitor this activity from outside the skull. ECoG may be performed either in the operating room during surgery or outside of surgery. Because a craniotomy is required to implant the electrode grid, ECoG is an invasive procedure.
Supplementary eye field (SEF) is the name for the anatomical area of the dorsal medial frontal lobe of the primate cerebral cortex that is indirectly involved in the control of saccadic eye movements. Evidence for a supplementary eye field was first shown by Schlag, and Schlag-Rey. Current research strives to explore the SEF's contribution to visual search and its role in visual salience. The SEF constitutes together with the frontal eye fields (FEF), the intraparietal sulcus (IPS), and the superior colliculus (SC) one of the most important brain areas involved in the generation and control of eye movements, particularly in the direction contralateral to their location. Its precise function is not yet fully known. Neural recordings in the SEF show signals related to both vision and saccades somewhat like the frontal eye fields and superior colliculus, but currently most investigators think that the SEF has a special role in high level aspects of saccade control, like complex spatial transformations, learned transformations, and executive cognitive functions.
The premotor cortex is an area of the motor cortex lying within the frontal lobe of the brain just anterior to the primary motor cortex. It occupies part of Brodmann's area 6. It has been studied mainly in primates, including monkeys and humans. The functions of the premotor cortex are diverse and not fully understood. It projects directly to the spinal cord and therefore may play a role in the direct control of behavior, with a relative emphasis on the trunk muscles of the body. It may also play a role in planning movement, in the spatial guidance of movement, in the sensory guidance of movement, in understanding the actions of others, and in using abstract rules to perform specific tasks. Different subregions of the premotor cortex have different properties and presumably emphasize different functions. Nerve signals generated in the premotor cortex cause much more complex patterns of movement than the discrete patterns generated in the primary motor cortex.
The supplementary motor area (SMA) is a part of the motor cortex of primates that contributes to the control of movement. It is located on the midline surface of the hemisphere just in front of the primary motor cortex leg representation. In monkeys the SMA contains a rough map of the body. In humans the body map is not apparent. Neurons in the SMA project directly to the spinal cord and may play a role in the direct control of movement. Possible functions attributed to the SMA include the postural stabilization of the body, the coordination of both sides of the body such as during bimanual action, the control of movements that are internally generated rather than triggered by sensory events, and the control of sequences of movements. All of these proposed functions remain hypotheses. The precise role or roles of the SMA is not yet known.
Premovement neuronal activity in neurophysiological literature refers to neuronal modulations that alter the rate at which neurons fire before a subject produces movement. Through experimentation with multiple animals, predominantly monkeys, it has been shown that several regions of the brain are particularly active and involved in initiation and preparation of movement. Two specific membrane potentials, the bereitschaftspotential, or the BP, and contingent negative variation, or the CNV, play a pivotal role in premovement neuronal activity. Both have been shown to be directly involved in planning and initiating movement. Multiple factors are involved with premovement neuronal activity including motor preparation, inhibition of motor response, programming of the target of movement, closed-looped and open-looped tasks, instructed delay periods, short-lead and long-lead changes, and mirror motor neurons.
Microstimulation is a technique that stimulates a small population of neurons by passing a small electrical current through a nearby microelectrode.
The primary motor cortex is a brain region that in humans is located in the dorsal portion of the frontal lobe. It is the primary region of the motor system and works in association with other motor areas including premotor cortex, the supplementary motor area, posterior parietal cortex, and several subcortical brain regions, to plan and execute voluntary movements. Primary motor cortex is defined anatomically as the region of cortex that contains large neurons known as Betz cells, which, along with other cortical neurons, send long axons down the spinal cord to synapse onto the interneuron circuitry of the spinal cord and also directly onto the alpha motor neurons in the spinal cord which connect to the muscles.
Michael Steven Anthony Graziano is an American scientist and novelist who is currently a professor of Psychology and Neuroscience at Princeton University. His scientific research focuses on the brain basis of awareness. He has proposed the "attention schema" theory, an explanation of how, and for what adaptive advantage, brains attribute the property of awareness to themselves. His previous work focused on how the cerebral cortex monitors the space around the body and controls movement within that space. Notably he has suggested that the classical map of the body in motor cortex, the homunculus, is not correct and is better described as a map of complex actions that make up the behavioral repertoire. His publications on this topic have had a widespread impact among neuroscientists but have also generated controversy. His novels rely partly on his background in psychology and are known for surrealism or magic realism. Graziano also composes music including symphonies and string quartets.
Neurostimulation is the purposeful modulation of the nervous system's activity using invasive or non-invasive means. Neurostimulation usually refers to the electromagnetic approaches to neuromodulation.
Cortical stimulation mapping (CSM) is a type of electrocorticography that involves a physically invasive procedure and aims to localize the function of specific brain regions through direct electrical stimulation of the cerebral cortex. It remains one of the earliest methods of analyzing the brain and has allowed researchers to study the relationship between cortical structure and systemic function. Cortical stimulation mapping is used for a number of clinical and therapeutic applications, and remains the preferred method for the pre-surgical mapping of the motor cortex and language areas to prevent unnecessary functional damage. There are also some clinical applications for cortical stimulation mapping, such as the treatment of epilepsy.
Cortical remapping, also referred to as cortical reorganization, is the process by which an existing cortical map is affected by a stimulus resulting in the creating of a 'new' cortical map. Every part of the body is connected to a corresponding area in the brain which creates a cortical map. When something happens to disrupt the cortical maps such as an amputation or a change in neuronal characteristics, the map is no longer relevant. The part of the brain that is in charge of the amputated limb or neuronal change will be dominated by adjacent cortical regions that are still receiving input, thus creating a remapped area. Remapping can occur in the sensory or motor system. The mechanism for each system may be quite different. Cortical remapping in the somatosensory system happens when there has been a decrease in sensory input to the brain due to deafferentation or amputation, as well as a sensory input increase to an area of the brain. Motor system remapping receives more limited feedback that can be difficult to interpret.
The following outline is provided as an overview of and topical guide to the human brain: