Probing and Regulating Dysfunctional Circuits Using Deep Brain Stimulation

Despite the best available medical treatments, many patients continue to be disabled by neurologic and psychiatric disorders, resulting in a large unmet need. Advances in imaging and neurophysiology over the last two decades have led to a reinterpretation of some neurologic and psychiatric conditions as primarily disorders of circuit function, or “circuitopathies.” These developments have been accompanied by advances in neurosurgical techniques with the increasingly widespread utilization of deep brain stimulation (DBS) to recalibrate dysfunctional circuits. The versatility of DBS as both a probe and modulator of neural circuits is making it a powerful tool to study the human brain, helping provide important details of the pathophysiology of circuit dysfunction. We are currently in a phase of active investigation to determine which circuits and disorders could be treated with DBS. Here we review recent advances in the DBS field and discuss potential future directions in targeted intracranial neuromodulation. The manifestations of many neurological and psychiatric disorders may arise as a consequence of abnormal activity in specific brain circuits. Here, Lozano and Lipsman review the use of deep brain stimulation to probe and modify activity in those malfunctioning circuits and discuss potential underlying mechanisms.