Neuromodulation: A Historical Perspective

Publisher Summary This chapter presents a brief history of the process of neuromodulation. Neuromodulation is considered as the chronic therapeutic electrical stimulation of the central nervous system or special nerves with an implanted stimulating device. This term does not apply to naturally occurring electrical stimulation, primitive electrical devices, cutaneous stimulation, acute or intraoperative stimulation, or sensory stimulation of peripheral nerves. The first documented electrical stimulation of the living human brain occurred in 1874. A patient with a purulent ulcer of the scalp with skull osteomyelitis was admitted to Good Samaritan Hospital in Cincinnati by Dr Roberts Bartholow. The parietal area of the brain became exposed when debridement was done and Bartholow made a faradic stimulation device to stimulate the exposed brain, since there was no such device to be purchased. When mechanical stimulation was done, there was no response, but when electrical stimulation was applied, contralateral muscle spasm was seen, documenting that the cortex was responsive to electricity. Ten years later, in 1884, the first intraoperative cortical electrical stimulation was performed by Sir Victor Horsley, the father of functional neurosurgery when he applied faradic electrical stimulation to the tissue within an occipital encephalocele, and demonstrated conjugate eye movements that he concluded were due to stimulation of the corpora quadrigemina. The twentieth century witnessed the development of a battery-powered device that was used to screen patients for dorsal column spinal cord stimulation for pain management. When it was modified to a more modern, safer, and convenient device, it was used for treatment as well as screening, thus giving birth to the process of trans-cutaneous stimulation.