ForewordJoseph J. Pancrazio, PhD

The National Institute of Neurological Disorders and Stroke

It is indeed an honor to provide a foreword for Neuromodulation. Without a doubt, this book bears the burden of being the first of its kind, and may well set the standard for efforts that follow. In the broad-est sense, neuromodulation involves the use of tech-nology to alter, adjust or modify neural activity. By its multidisciplinary nature, the research and develop-ment underlying neuromodulation draws upon the talents and experience of scientists, engineers, and cli-nicians, often working most productively as teams. In addition, the emergence of neuromodulation in sev-eral cases from the proof-of-concept stage to a clini-cal standard of care has also brought individuals with business experience to the field. This reference work is not an exception to this team science endeavor; it too is the product of a diverse group of multidisciplinary individuals who share the vision of relieving the bur-den of neurological diseases and injuries through the judicious use of devices.

The charge for the contributors is consequently and necessarily ambitious: to convey the basic, transla-tional, and clinical science underlying neuromodula-tion while providing insight into the ethical, corporate, and historical bases for such devices. Therefore, the scope of the book is wide, encompassing theoretical, applied, and logistical issues. For readers with inter-ests in basic science, there is information concern-ing the fundamentals of the nervous system with emphasis on neurobiology, neuroanatomy, and the basis for electrical stimulation/recording. For readers with clinical interests, there are chapters that address the physiology and pathophysiology of regions of the nervous system relevant to movement disorders, pain, epilepsy, and psychiatric illnesses such as depres-sion and obsessivecompulsive disorder. For clinical practitioners, the book surveys neuromodulation

approaches, primarily through electrical stimulation and drug delivery, to treat a range of neurological dis-orders. Of no less importance is the chapter concerned with ethical issues a significant challenge since neu-romodulation can affect the capacity of patient to pro-vide consent. In addition, the chapter entitled Whom Do We Serve? reminds the reader that this book is about treating patients. While the notion of implanted devices that interact with the nervous system may inspire the fantasies of enhancement among science fiction enthusiasts, the goal of neuromodulation is to relieve the burden of neurological disease.

Insights into the future of neuromodulation require reflection on what has driven its success. While studies in basic neuroscience have been essen-tial, neuromodulation is also indebted to advances in engineering and physics. Implanted devices of ever increasing sophistication have been enabled by the age of the integrated circuit, microfabrication meth-odologies, and higher density power storage systems. Physics has provided non-invasive real-time imaging technologies that allow an unprecedented view of the anatomy and functionality of the nervous system in health and disease. Indeed, hypothesis-driven applica-tions of implanted systems are emerging where seem-ingly simple block diagram representations of neural network pathways important to neurological disease drive the choice of implantation targets. It is expected that this trend towards modeling will continue and become more sophisticated and the device capabili-ties will grow such that the activity of dysfunctional networks or even neurons will be selectively and pre-cisely modulated in patients. Undoubtedly, to fully embrace this potential, neuromodulation will con-tinue to be a multidisciplinary pursuit capitalizing on the strength of diverse teams.xxi

Foreword