Indications and Ethical Considerations of Deep Brain Stimulation

  • J. Siegfried
  • Y. Lazorthes
  • R. Sedan
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 30)


Electrical impulses through chronically implanted electrodes in the human brain are used today in the relief of chronic crippling pain, motor movement disorders and behavior disturbances. A great number of reports from animal studies and several descriptions of the results produced by human Stimulation seem to suggest that pain can often be adequately controlled. However, the perspectives of such methods raise many ethical problems and ask for caution. Nervous tissue damage after long-term Stimulation, biochemical modifications, electrode migration and long-term follow-up of its clinical value are still under study and are the factors which might limit for the time being the indications. A restrictive role for this procedure is advocated for: 1. cases of chronic facial pain, 2. cases of chronic pain in other locations where other neurosurgical Operations have failed and where the patient is not too young and is not suffering from pain of benign origin.


Chronic Pain Deep Brain Stimulation Functional Electrical Stimulation Periaqueductal Gray Matter Neurosurgical Department 
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  1. 1.
    Adams, J. E., Hosobuchi, Y., Fields, H., Stimulation of internal capsule for relief of chronic pain. J. Neurosurg.41 (1974), 740–744.PubMedCrossRefGoogle Scholar
  2. 2.
    Agnew, W. F., Yuen, T. G. H., Pudenz, R. H., Bullara, L. A., Electrical Stimulation of the brain. IV. Ultrastructural studies. Surg. Neurol. 4 (1975), 438–448.PubMedGoogle Scholar
  3. 3.
    Baudouin, A., Puech, P., Premiers essais d’intervention directe sur le thalamus (injections, electrocoagulations). Rev. Neurol.81(1949), 78–81.Google Scholar
  4. 4.
    Bettag, W., Yoshida, T., Uber stereotaktische Schmerzoperationen. Acta Neurochir. (Wien) 8 (1960), 299–317.CrossRefGoogle Scholar
  5. 5.
    Brummer, S. B., Turner, M. J., Electrochemical considerations for safe electrical Stimulation of the neurons system with platinum electrodes. IEEE Trans. Biomed. Eng. BME 23 (1977), 59–63.CrossRefGoogle Scholar
  6. 6.
    Dieckmann, G., Chronic mediothalamic Stimulation for control of phobias. In: Modern Concepts in Psychiatric Surgery, pp. 85–93 (Hitchcock, E. R., Ballantine, H. T., Meyerson, B. A., eds.). Elsevier: North-Holland, publ. 1979.Google Scholar
  7. 7.
    Gilbert, J. P., McPeek, B., Mosteller, F., Statistics and ethics in surgery and anaesthesia. Science 198 (1977), 684–689.PubMedCrossRefGoogle Scholar
  8. 8.
    Heath, R. G., Electrical self-stimulation of the brain in man. Amer. J. Psychiat. 120 (1963), 571–577. PubMedGoogle Scholar
  9. 9.
    Heath, R. G., Mickle, W. A., Evaluation of seven years’ experience with depth electrodes studies in human patients. In: Electrical Studies on the Unanesthe- sized Brain, pp. 214–247 (Ramey, E. R., O’Doherty, D. S., eds.). New-York: P. B. Hoeber. 1960.Google Scholar
  10. 10.
    Hecaen, H., Talairach, J., David, M., Dell, M. B., Coagulations limitees du thalamus dans les algies du Syndrome thalamique. Rev. Neurol.81(1949),917–931.Google Scholar
  11. 11.
    Herbert, V., Acquiring new information while retaining old ethics. Science 198 (1977),690–693.PubMedCrossRefGoogle Scholar
  12. 12.
    Hosobuchi, Y., Adams, J. E., Rutkin, B., Chronic thalamic Stimulation for the control of facial anesthesia dolorosa. Arch. Neurol.29 (1973), 153–169.CrossRefGoogle Scholar
  13. 13.
    Jonson, A. R., Do no harm. Ann. intern. Med.88 (1978), 827–832.Google Scholar
  14. 14.
    Liebeskind, J. C., Guilbaud, G., Besson, J. M., Analgesia from electrical Stimulation of the periaqueductal gray matter in the cat: behavioral observations and inhibitory effects on spinal cord interneurons. Brain Res. 50 (1973), 441–446.PubMedCrossRefGoogle Scholar
  15. 15.
    Lilly, J. C., Injury and excitation by electric currents. In: Electrical Stimulation of the brain, pp. 60–64 (Sheet, D. W., ed.). Austin: University of Texas Press. 1961.Google Scholar
  16. 16.
    Mark, V. H., Ervin, F. R., Hackett, T. P., Clinical aspects of stereotactic thalamotomy in the human. I. The treatment of chronic severe pain. Arch. Neurol. 3 (1960), 351–367.PubMedCrossRefGoogle Scholar
  17. 17.
    Mazars, G., Rüge, R., Mazars, Y., Resultats de la Stimulation du faisceau spino-thalamique et leur incidence sur la Physiopathologie de la douleur. Rev. Neurol.103 (1960), 136–138.Google Scholar
  18. 18.
    Mazars, G., Merienne, L., Cioloca, C., Stimulations thalamiques intermittentes antalgiques. Rev. Neurol. 128 (1973), 273–279.PubMedGoogle Scholar
  19. 19.
    Mayer, D. J., Wolfle, T. L., Akil, H., Analgesia from electrical Stimulation in the brain stem of the rat. Science 174 (1971), 1351–1354.PubMedCrossRefGoogle Scholar
  20. 20.
    Meyerson, B., Co-operative study on deep brain Stimulation for pain. 3rd Workshop on Neurostimulation, Megeve, March 30–31, 1979 (not published).Google Scholar
  21. 21.
    Mortimer, J. T., Shealy, C. N., Wheeler, C., Experimental nondestructive Stimulation of the brain and spinal cord. J. Neurosurg. 32 (1970), 553–559.PubMedCrossRefGoogle Scholar
  22. 22.
    Mundinger, F., Neue stereotaktisch-funktionelle Behandlungsmethode des Torticollis spasmodicus mit Hirnstimulatoren. Med. Klin. 72 (1977), 1982–1986.PubMedGoogle Scholar
  23. 23.
    Pudenz, R. H., Report of the neural damage panel. In: Functional Electrical Stimulation, Vol. 1, pp. 479–482 (Hambrecht, F. T., Reswick, J. B., eds.). New York-Basel: Dekker. 1977.Google Scholar
  24. 24.
    Pudenz, R. H., Agnew, W. F., Bullara, L., Effects of electrical Stimulation of the brain. Light and electron microscope studies. Brain, Behavior and Evol. 14 (1977), 103–124.CrossRefGoogle Scholar
  25. 25.
    Pudenz, R. H., Agnew, W. F., Yuen, T. G. H., Bullara, L. A., Electrical Stimulation of brain. In: Functional Electrical Stimulation, Vol. 1, pp. 437–457 (Hambrecht, F. T., Reswick, J. B., eds.). New York-Basel: Dekker. 1977.Google Scholar
  26. 26.
    Pudenz, R. H., Bullara, L. A., Dru, D., Talalla, A., Electrical Stimulation of the brain. II. Effects on the blood-brain barrier. Surg. Neurol. 4 (1975), 265–270.PubMedGoogle Scholar
  27. 27.
    Pudenz, R. H., Bullara, L. A., Jacques, S., Hambrecht, F. T., Electrical Stimulation of the brain. III. The neural damage model. Surg. Neurol. 4 (1975), 389–400.PubMedGoogle Scholar
  28. 28.
    Reynolds, D. V., Surgery in the rat during electrical analgesia induced by focal brain Stimulation. Science 164 (1969), 444–445.PubMedCrossRefGoogle Scholar
  29. 29.
    Richardson, D. E., Akil, H., Pain reduction by electrical brain Stimulation in man. J. Neurosurg. 47 (1977), 178–194.PubMedCrossRefGoogle Scholar
  30. 30.
    Riechert, T., Die chirurgische Behandlung der zentralen Schmerzzustände, einschließlich der stereotaktischen Operationen im Thalamus und Mesence- phalon. Acta Neurochir. (Wien) 8 (1960), 136–152.CrossRefGoogle Scholar
  31. 31.
    Sedan, R., Lazorthes, Y., La neurostimulation electrique therapeutique. Neurochirurgie 24, Suppl. 1, 138 pp. (1978).Google Scholar
  32. 32.
    Siegfried, J., Indications and ethical consideration on deep brain Stimulation. 3rd European Workshop on Neurostimulation, Megeve, March 30–31, 1979 (not published).Google Scholar
  33. 33.
    Spiegel, E. A., Wycis, H. T., Mesencephalotomy for relief of pain. In: Anni- versary Volume for O. Poetzl, Vienna, p. 438 (1948).Google Scholar
  34. 34.
    Talairach, H., Hecaen, H., David, M., Monnier, M., Ajuriaguerra, J. de, Recherches sur la coagulation therapeutique des structures sous-corticales chez l’homme. Rev. Neurol. 81 (1949), 4–24.Google Scholar

Copyright information

© Springer-Verlag 1980

Authors and Affiliations

  • J. Siegfried
    • 1
  • Y. Lazorthes
    • 2
  • R. Sedan
    • 3
  1. 1.Neurosurgical DepartmentUniversity of ZürichZürichSwitzerland
  2. 2.Neurosurgical DepartmentUniversity of ToulouseFrance
  3. 3.Neurosurgical DepartmentUniversity of MarseilleFrance

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