Deep brain stimulation and autonomic control.

Deep brain stimulation (DBS) in humans has come of age as a tool to treat a panoply of disease states including Parkinson's disease tremor and dystonia and a panoply of other disease states including headache, epilepsy, obesity, eating disorders, depression, obsessive compulsive disorder, Tourette's syndrome, addiction and chronic pain. Increasingly, practitioners of DBS are reporting autonomic side effects, which intriguingly, sometimes result in improved autonomic function. Focussing on the effects of stimulation at periaqueductal and periventricular sites on cardiovascular function and control of micturition, this review shows that data obtained from studies in both animals is now being confirmed in humans. Lowering of blood pressure, improved baroreflex function can be evoked by midbrain DBS in animals and humans. Increased bladder capacity has also been shown in rats and humans following midbrain DBS. The findings highlight the tantalizing possibility that DBS could be developed for treatment of dysfunctional autonomic states in humans.