Deep brain stimulation

Image:DBS.pngDeep brain stimulation (DBS) is one of a group of treatments involving surgical implantation of a medical device called brain pacemaker which sends electrical impulses to specific parts of the brain. This surgical procedure is used to treat severe essential tremorand tremor, rigidity and bradykinesia(slow movement) associated with Parkinson's disease, as well as primary dystoniaand other conditions. Brain pacemakers were approved by FDAin 1997as a treatment for epilepsy [1](this kind of treatment is called vagus nerve stimulation, not deep brain stimulation) and Parkinson's disease as well as essential tremor [2][3], and in April 2003as a treatment for primary dystonia [4]. In March 2005, the results of a Canadianstudy were published indicating that DBS may also alleviate symptoms in patients suffering from treatment-resistant clinical depression.

Parkinson's disease

The surgery involves craniotomyfor implantation of an electrodeinto the thalamusor basal gangliaof the brain. The electrode is powered by a battery-operated neurostimulator placed under the collar bone. Electrical stimulation through the electrode interferes with neuralactivityat the target site (usually specific areas of the thalamus or the subthalamic nucleusand pallidumof the basal ganglia) which can alleviate tremors, rigidity or bradykinesia. The choice of target site depends on the symptoms being addressed. After the surgery is completed, an expert calibrates the unit in order to maximize its effectiveness. The programming of the neurostimulator can take up to a year to achieve an optimal setting.

Typically DBS is performed unilaterally on the side of the brain opposite to the side of the body most debilitated by the disease, but in many cases it is performed bilaterally in a single operation.

DBS has been found to significantly alleviate symptoms in two thirds of Parkinson's patients, and has recently been used more frequently to treat cases of severe essential tremor.

Although DBS is a procedure performed on the brain, it is FDAapproved in the United Statesand carries the risks of major surgery.

The post-surgical complication rate is proportional to the experience of the surgical team with a tipping point of 50 DBS procedures and a cushion of 100 DBS procedures.

Depending upon usage, the battery in the neurostimulator must be replaced after three to five years. Due to the necessity to maintain an uncontaminated field within the body, the entire unit must be reimplanted. Nevertheless, this is a minor surgical procedure involving only the shallow subclavicular pocket where the neurostimulator resides.

Remaining battery life may be reliably determined with a telemetric programmer so that arrangements can be made to replace the unit prior to battery failure.

Clinical depression

Dr. Helen Mayberg of the University of Toronto, Dr. Andres Lozano of Toronto Western Hospital, and Dr. Sidney Kennedy of Canada's University Health Network (UHN) reported their discovery in the March 3, 2005edition of Neuron that electricalstimulation of a small area of the frontal cortexbrought about a "striking and sustained remission" in four out of six patients suffering from clinical depression, whose symptoms had previously been resistant to medication, psychotherapyand electroconvulsive therapy.

The researchers reported that, using brain imaging, they noticed that activity in the subgenual cingulate region (SCR or Cg25) — the lowest part of a band of tissue that runs along the midline of the brain— seemed to correlate with symptoms of sadness and depression. They implanted electrodes into six patients while they were locally anesthetised, but alert. While the current was switched on, four of the patients reported feeling a black cloud lifting, and became more alert and interested in their environments. The changes reversed when the current was switched off.

The effects of continuous SCR stimulation have produced sustained remissionfrom depression in the four patients for six months, the team reported.

References

• "Surgeons Help Severely Depressed Patients by 'Re-Tuning' Circuits"by Ron Garal, Daily News Central, March 1, 2005
• "Surgery that made me smile"by David Beresford, The Guardian, June 9, 2005
• "Pacemaker for the brain may offer control for severe depression", by Kristin Weidenbach, Stanford Report, October 11, 2000.
• "'Brain pacemaker' treats primary dystonia", April 2003.
• "Brain Pacemaker. Implantable electroshock therapy eases depression.", by

William Speed Weed, Popular Science, August 2004.

• "A pacemaker for the brain", the Cleveland Clinic Health Information Center.

External links

• Neuron
• Deep brain stimulation article from the Surgery Encyclopedia
• Wireheading.comnl:Diepe hersenstimulatie

tr:Derin beyin stimülasyonu

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Deep+brain+stimulation Wikipedia article Deep brain stimulation.