Re-Engineering the Subthalamus

Abstract

This historical vignette of the region known as “subthalamus” is timely and brings up how our current concepts regarding this region have evolved into the current level of high clinical importance for clinical treatment schemes. This pertinent review of older literature (particularly prior to 1990) highlights how previous concepts as to functioning and treatment in this region have been redefined and improved (1). Whereas most efforts at treatment of this region are now focused on motor disorders (ie, tremor and Parkinson’s disease) this vignette outlines the wide variety of other disorders once considered as involving the subthalamus, including epilepsy (16), chronic pain, and behavioral disorders, as neurosurgeons experimented to define the function of this region. Additionally, the authors include previous treatment paradigms (ie, various forms of lesioning, the previous mainstay of generating a treatment effect), now mostly supplanted by long-term electrical stimulation with deep brain stimulation (DBS), gene therapy approaches to modify long-term cellular function, and other biological or cellular treatments, all focused on augmentation of function rather than lesioning.