Neurosurgical treatment
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Deep brain stimulation (DBS ) is a surgical procedure that implants a neurostimulator and electrodes which sends electrical impulses to specified targets in the brain responsible for movement control. The treatment is designed for a range of movement disorders such as Parkinson's disease , essential tremor , and dystonia , as well as for certain neuropsychiatric conditions like obsessive-compulsive disorder (OCD) and epilepsy .[ 1] The exact mechanisms of DBS are complex and not entirely clear, but it is known to modify brain activity in a structured way.[ 2]
DBS has been approved by the Food and Drug Administration as a treatment for essential tremor and Parkinson's disease (PD) since 1997.[ 3] DBS was approved for dystonia in 2003,[ 4] obsessive–compulsive disorder (OCD) in 2009, and epilepsy in 2018.[ 5] [ 6] [ 7] DBS has been studied in clinical trials as a potential treatment for chronic pain , for various affective disorders, including major depression , for Alzheimer's Disease and drug addiction , among other brain disorders. It is one of few neurosurgical procedures that allow blinded studies .[ 1]
As a first approximation, DBS is thought to mimic the clinical effects of lesioning [ 8] , likely by attenuating (pathologically elevated) information flow through affected brain networks[ 9] . Thus, DBS is thought to create an 'informational lesion'[ 10] , which can be switched off by turning off the DBS device, i.e. is reversible. This is a strong advantage compared to actual brain lesions that are at times also surgically applied to similar targets in similar conditions and which are permanent.
^ a b Kringelbach ML, Jenkinson N, Owen SL, Aziz TZ (August 2007). "Translational principles of deep brain stimulation". Nature Reviews. Neuroscience . 8 (8): 623–635. doi :10.1038/nrn2196 . PMID 17637800 . S2CID 147427108 .
^ García MR, Pearlmutter BA, Wellstead PE, Middleton RH (16 September 2013). "A slow axon antidromic blockade hypothesis for tremor reduction via deep brain stimulation" . PLOS ONE . 8 (9): e73456. Bibcode :2013PLoSO...873456G . doi :10.1371/journal.pone.0073456 . PMC 3774723 . PMID 24066049 .
^ "FDA approves brain implant to help reduce Parkinson's disease and essential tremor symptoms" . FDA . Retrieved May 23, 2016 . The first device, Medtronic's Activa Deep Brain Stimulation Therapy System, was approved in 1997 for tremor associated with essential tremor and Parkinson's disease.
^ Phillips S (17 June 2007). " 'Brain pacemaker' for a rare disorder" . NBC News . Archived from the original on April 28, 2021.
^ "Medtronic Receives FDA Approval for Deep Brain Stimulation Therapy for Medically Refractory Epilepsy" (Press release). Medtronic. 1 May 2018.
^ "FDA Approves Humanitarian Device Exemption for Deep Brain Stimulator for Severe Obsessive-Compulsive Disorder" . FDA .
^ Gildenberg PL (2005). "Evolution of neuromodulation". Stereotactic and Functional Neurosurgery . 83 (2–3): 71–79. doi :10.1159/000086865 . PMID 16006778 . S2CID 20234898 .
^ Morris JG, Owler B, Hely MA, Fung VS (2007). "Hydrocephalus and structural lesions". Parkinson's Disease and Related Disorders, Part II . Handbook of Clinical Neurology. Vol. 84. pp. 459–478. doi :10.1016/S0072-9752(07)84055-3 . ISBN 978-0-444-52893-3 . OCLC 1132129865 . PMID 18808964 .
^ Hollunder, Barbara; Ostrem, Jill L.; Sahin, Ilkem Aysu; Rajamani, Nanditha; Oxenford, Simón; Butenko, Konstantin; Neudorfer, Clemens; Reinhardt, Pablo; Zvarova, Patricia; Polosan, Mircea; Akram, Harith; Vissani, Matteo; Zhang, Chencheng; Sun, Bomin; Navratil, Pavel (March 2024). "Mapping dysfunctional circuits in the frontal cortex using deep brain stimulation" . Nature Neuroscience . 27 (3): 573–586. doi :10.1038/s41593-024-01570-1 . ISSN 1097-6256 . PMC 10917675 . PMID 38388734 .
^ Grill, Warren M.; Snyder, Andrea N.; Miocinovic, Svjetlana (May 2004). "Deep brain stimulation creates an informational lesion of the stimulated nucleus:" . NeuroReport . 15 (7): 1137–1140. doi :10.1097/00001756-200405190-00011 . ISSN 0959-4965 .