Deep Brain Stimulation for Movement Disorders
Douglas Kondziolka, MD
Hello, I’m Dr. John Whyte, chief medical expert for Discovery Channel. Now there is a surgical option for patients diagnosed with movement disorders. It’s called deep brain stimulation and although invasive it doesn’t destroy brain tissue.
Using electrical current to control overactive circuits in the brain, this surgery offers new hope to patients. Think of it as a pacemaker for the brain. Deep brain stimulation is also in clinical trials for other illnesses such as depression and chronic pain. UPMC’s Dr. Douglas Kondziolka, a leader in deep brain stimulation, will tell us how it works.
Deep brain stimulation is a surgical procedure where narrow electrodes are placed into the brain, usually in one, maybe two, and sometimes even more targets to affect the circuitry of the brain. We know the brain is an electrical organ, and over the last couple of decades we’ve been able to identify that certain portions of the circuit are abnormal in certain disorders. So for example in Parkinson’s disease, which is a problem where a certain chemical, Dopamine, is missing from the brain, the downstream effects of that loss in other parts of the brain are overactive. In tremor there is a part of the brain in the thalamus where the cells are overactive, and in certain other types of things, epilepsy, thought disorders such as obsessive compulsive disorder, or even depression, parts of the brain circuitry are overactive.
So, with deep brain stimulation we identify those areas, and that’s done through the placement of an accuracy system, a guiding frame, a detailed type of brain scan, and computerized mapping, which sometimes can even involve identification of specific cells in the brain where we place this thin little wire down into that target. That wire is hooked up to a cable which runs under the skin, often on both sides, and then a battery attached to a cable placed under the skin below the collarbone , that is used to run electricity — usually all day long — to turn off the brain circuit.
And the effect is reversible, so if the person has tremor and the device is turned on so the tremor is dampened. If you turn the device off, within five or 10 seconds that tremor will start to come back. Although it’s a surgical procedure and therefore invasive, the degree of invasiveness is quite low. So the incisions are small, the opening in the skull bone is small. The opening in the surface of the brain is very tiny. So often these are performed in more elderly patients, but the safety profile has been excellent.
One of the things that we typically think about neurosurgery, however, is that it’s kind of at the end, it’s a more of a last-ditch thing to do. And so over the years many of the patients we saw had been on medicine for a long time, were deteriorating, and then were sent for neurosurgical care, whereas we probably could have helped them a lot more to reduce disability if we had seen them early.
UPMC has been involved in deep brain stimulation from the very beginning, almost 15 years now since the original indications for tremor and later for the muscular problem of dystonia. But more recently, we’ve been involved in some research studies related to major depression that has been poorly treated by conventional means. So that’s a very exciting line of work because severe, intractable depression can be a devastating thing to patients and families, and we are starting to understand the circuitry of depression. So by placing electrodes into those locations, we hope to turn off areas of sadness. Again, it’s reversible, and we are undergoing those research studies right now. It may be in the future that the system is entirely in the head, and doesn’t involve cables and batteries, and is wireless, and I think that’s coming pretty soon.
Deep brain stimulation offers patients diagnosed with debilitating movement disorders a higher quality of life. It’s important to know that this procedure exists and could be considered for patients earlier in their treatment rather than as last resort.
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