High frequency subthalamic nucleus stimulation

The remarkable clinical effectiveness of deep brain stimulation (DBS) for the treatment of an expanding range of neurological dysfunction will have profound implications. DBS has given emphasis to a whole new approach utilizing the electrical nature of brain function. Quite the contrary, evidence shows that high frequency DBS drives the output of the simulated structures. Ashby et al. provided evidence that excitation of axons by subthalamic DBS mediates DBS effects on electromyographic activity, while Baker et al. demonstrated the axonal mediation of subthalamic DBS-evoked scalp poten-tials. The current model, as described above, for the physiology and pathophysiology of the basal ganglia is in need of radical revision if not outright elimination. The previous anatomically based metaphor has resulted in simplistic notions that, unfortunately, have been found to be epiphenomenonally true as special cases and has created false local minima in our ignorance of basal ganglia physiology and pathophysiology.