The Gathering Momentum Behind Deep Brain Stimulation

The idea of applying electricity to the brain might conjure an image of the birth of Frankenstein for some. For others, the idea can bring to mind the controversial use of electroshock therapy in treating depression, psychosis and schizophrenia - sometimes against the will of the patient. Indeed, given the importance of brain operation in defining who we are, the application of electricity to the brain is not typically viewed in a positive light.

Given the intensely complex interconnections of the nerve cells in the brain and the perceived risk of life-altering injury, it is quite understandable to consider such a treatment as primitive. However, the application of electricity in this manner, called Deep Brain Stimulation (DBS), is currently showing benefit for many patients. At the same time, research into the use of the technology is also uncovering other applications for this treatment to other illnesses.

For those patients who can benefit from the treatment, Deep Brain Stimulation is provided by a surgically implanted medical device. The device fundamentally consists of an electrical signal generator attached to wires that are placed at specific locations within the brain. In contrast to electroshock therapy, the amount of energy applied to the brain by Deep Brain Stimulation devices is between 100 to 500 times less. While this reduction in energy does not automatically mean that the treatment is safe, it certainly suggests more subtlety to the effects than those of electroshock therapy.

While the benefits of DBS have been observed for some time, the reason for their effectiveness was largely unknown. One theory was that the applied electricity provided its desired effect by disrupting the brain's electrical signaling in close proximity to the wires. Only very recently has research from Cold Spring Harbor Laboratory determined that the treatment increases in the number of neurons or nerve brain cells in the area of the brain responsible for memory emotions and behavior. The treatment causes some of the same benefits as seen from physical exercise and medications like Prozac.

Despite being researched as far back as the 1960s, Deep Brain Stimulation was not available for patient treatment in the US until 1997 when it was first approved for treating seizures and tremors. Subsequently, in 2002, it was approved for the treatment of Parkinson's disease. Since that time, it has also been applied to the treatment of chronic pain and major depression. Even though it has been a treatment option for a number of years, its use is still often reported by the media as new.

Definitely not new, Deep Brain Stimulation has been used for several years in treating those with serious depression who have not responded to medications. In separate studies from the University Health Network in Toronto and the University of Bonn, researchers have observed significant and lasting improvements in the symptoms experienced by those with extreme depression. In one of the studies, researchers observed that more 70% of patients experienced at least a 40% reduction in depressive symptoms. With major depression affecting approximately 7% of the population and as many as 2 in 10 depressed patients being unresponsive to medications, the technology could help a significant number of people.

Having also been in use by Parkinson's patients for a number of years with more than 80,000 patients worldwide now implanted with brain stimulators, research on the long term use of Deep Brain Stimulation has also shown positive results. Neurologists from Cedars-Sinai Medical Center observed that the movement problems of patients having stimulator implants were largely stabilized over five years. In contrast, patients not implanted with a stimulator continue to lose muscle control. Though these study results point to a need for further investigation, they do show promise in using the technology to slow the progression of the disease.

With regard to another age-related disease of the brain, DBS is also showing promise. Research physicians from Toronto Western Hospital observed benefits in memory retention among 50% of their Alzheimer's patients who were implanted with a brain stimulator. Although the study was a small one and requires a larger follow-up study to confirm the results, the research effort does suggest that the relatively uncomplicated procedure could be of benefit to patients with the disease.

For another condition of the brain, Epilepsy, long term studies on patients with the stimulator implant have shown significant reductions in the rate of seizures. An observational study led by the Stanford Epilepsy Center and involving almost 20 medical institutions determined that 3 years following stimulator implant surgery, the average patient was experiencing a 68% lower rate of seizures. Given that the study participants did not respond to antiepileptic medications, these finding offer hope where no previous treatments have been available.

One last area of interest in the use of Deep Brain Stimulation is in the treatment of a particular form of Cerebral Palsy. Research published in the Lancet in mid 2009 reported an average 24% increase in controlled movement amongst those implanted with the device. At the same time most patients experienced a decrease in pain and disability one year following their surgery. These findings are very positive because they offer promise for a condition that currently has no other treatment.

Though a number of the uses of this treatment technology have been outlined here, the field of Deep Brain Stimulation continues to grow. A future article will cover additional ways in which the treatment is benefiting patients as well as the current risks involved.

Related Links

http://hypertextbook.com/facts/2005/GinaCastellano.shtml
http://professional.medtronic.com/products/activa-pc-deep-brain-neurostimulator/
http://www.ncbi.nlm.nih.gov/pubmed/314229
http://www.ncbi.nlm.nih.gov/books/NBK16493/
http://www.cshl.edu/Article-Enikolopov/cshl-scientists-identify-elusive-neuronal-targets-of-deep-brain-stimulation
http://investors.sjm.com/phoenix.zhtml?c=73836&p=irol-newsArticle_print&ID=1289452
http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml
http://www.alphagalileo.org/ViewItem.aspx?ItemId=94724&CultureCode=en
http://www.cedars-sinai.edu/About-Us/News/News-Releases-2011-/Does-DBS-stall-symptom-progression.aspx
http://www.uhn.ca/applications/iNews/ViewStory.aspx?s_id=890
http://wwwp.medtronic.com/Newsroom/NewsReleaseDetails.do?itemId=1260129003323&lang=en_US
http://www.eurekalert.org/pub_releases/2009-07/l-dbs063009.php

It's quite interesting. But can it helpful?

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