Deep brain stimulation

Deep brain stimulation
Deep brain stimulation
	DBS-probes shown in X-ray of the skull (white areas around maxilla and mandible represent metal dentures and are unrelated to DBS devices)
Specialty	Neurosurgery
MeSH	D046690
MedlinePlus	007453
	[edit on Wikidata]

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.

[Kringelbach-1] 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_Pearlmutter_Wellstead_Middleton_2013-2] 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.

[3] "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.

[4] Phillips S (17 June 2007). "'Brain pacemaker' for a rare disorder". NBC News. Archived from the original on April 28, 2021.

[5] "Medtronic Receives FDA Approval for Deep Brain Stimulation Therapy for Medically Refractory Epilepsy" (Press release). Medtronic. 1 May 2018.

[6] "FDA Approves Humanitarian Device Exemption for Deep Brain Stimulator for Severe Obsessive-Compulsive Disorder". FDA.

[gildenberg-7] Gildenberg PL (2005). "Evolution of neuromodulation". Stereotactic and Functional Neurosurgery. 83 (2–3): 71–79. doi:10.1159/000086865. PMID 16006778. S2CID 20234898.

[8] 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.

[9] 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.

[10] 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.

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