Probing new targets for movement disorders

Two Parkinson's patients receive deep brain stimulation (DBS) in their subthalamic nuclei. Despite accurate electrode placement, one patient is able to stand up and walk effortlessly around the room while the other breaks down into uncontrolled sobbing that only stops once the stimulator is turned off. This paradox exposes one of the major roadblocks in developing therapies for brain disorders: the elaborate and diffuse nature of neural circuits. Physically proximal neurons are often engaged in functionally different pathways; whereas modulation of one pathway might be therapeutic, modulation of those surrounding it may produce debilitating side effects. The problem with high-amplitude electrical stimulation, as applied during DBS, is that it affects not only the activity of neurons around the electrode, but also the activity of neurons whose long extensions happen to pass by the electrode.