Deep Brain Stimulation

Mark Anil MansinghSimon Putzenlechner

Philipp Bartner

Introduction

• „Pacemaker“ for brain• Reversible neurosurgical procedure• approx. 120000 patients treated worldwide• Remarkably increases lifequaltiy

Indications

• Tremor• Parkinsons• Dystonia• OCDs• Epilepsy

Function

• ??? not completely understood ???

• Functional block of axons• Synaptic Inhibtion• Exhaustion of NTMs via continous excitation• changes in pathological activity of brain

Device

• battery-powered chipcontrolled pacemaker

Trail in 2010: 8 contacs per hemisphere

Side effects

• Dysarthria (short- / longterm)• Manic behavior• Depression

• Sources:• http://de.wikipedia.org/wiki/Tiefe_Hirnstimulation• http://www.ninds.nih.gov/disorders/deep_brain_stimulation/

deep_brain_stimulation.htm

History of DBS• Electricity and its effects on human body in

early age experiments with electric rays

• 1800‘s: electricity became useable for humans

mapping of brain cortex

• 1938: electric shock therapy as treatment of severe psychosis

• 1947: Ernst Spiegel and Henry Wycislocalize BG via electrical stimulation and destruction of certain areas by

radiofrequency therapy stimulation itsself has therapeutic

effect

• DBS became focus for further research

• Many treatment possibilities were only found by chance not by planning

• Middle aged heroin addict, 22 years of therapy but all therapies failed

DBS surgery first effect: drastic increase in heroin consumption

• 2006 Jens Kuhn trying to treat apanic disorder patient after DBS panic attacks were left unchanged, but his alcohol intake was unintentionally decreased

Drug dependace therapy

• 2013 treatment of obesityinstead of treating obesity, a patient was left with an enhanced memory capacity, making him able to recall detailed memories from 30 years prior

• Chance of Alzheimer‘s disease treatment?

• Also ethical problems may arise from DBS

• DBS is today used to treat:– Parkinson's disease– Chronic pain– Major depression– Tourette syndrome– epilepsy that is resistant to medication

• Sources:– http://www.scientificamerican.com/article/psychiatrists-embrace-dee

p-brain-stimulation/?page=2– http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157831/– http://en.wikipedia.org/wiki/Deep_brain_stimulation

Applications of deep brain stimulation.

Parkinsonsins What is parkinsons?

When is it used? When drugs don’t alleviate

Pathophysiology is not understood, it stimulates nerve cells

Different areas of the brain can be targeted for this treatment :

• Subthalamic nucleus • Globus Pallidus

• Can also target other sites such as zona incerta

Drawbacks of DBS

Always prefer conservative methods of treatment first. (also with depression and turett’s, and chronic pain)

DBS carries with it all the risks of major surgery. Hemorrhage and infection can occur incidence less than 5 percent.