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The Technology of Deep Brain Stimulation: Current Challenges and Future Perspectives

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Neuroscience is a fascinating field. Our skulls essentially house a giant super computer that allows us to function, from tasks like fine-motor skills to breathing, our brain does it all. For some individuals though, their brains get signals confused or the signals are either not strong enough or too strong, and this creates problems. These individuals can take medications to lessen symptoms and through therapies, attempt to regain a better quality of life, despite their conditions. Even with all these treatments, some still require further support and this is where neuroscience, and more specifically, deep brain stimulation techniques, come into play.Deep brain stimulation is a neuroscience technique that has been proven effective to alleviate certain movement, mood, and memory disorders. During the neurosurgery, patients are lightly sedated so that they are still awake and can describe to the surgeon what they’re feeling or experiencing. The surgeon implants two electrodes (one for each side) into different regions of the brain depending on the condition they’re trying to address. After the patient has had time to heal from the first surgery, they then undergo a secondary surgery to place a pacemaker, which acts as a battery for the electrodes in the brain, into the chest cavity. This is what the doctors will use to activate the electrodes and deliver electrical messages to the brain. Depending on the patient’s condition and it’s severity, the electrodes may be stimulated all day, or just for portions of the day. The doctors then work with the patient to figure out what the ideal frequency is for their condition, and completely customize it’s settings unique to them. Effectively, this technique allows neurologists to “turn up” or “turn down” the impulses that control the symptoms of their conditions that make functional living skills difficult, if not impossible. (Lozano, 2013)

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If you’ve lived with severe Parkinson’s and have lost your ability to sign your name, feed yourself, or pick up something, and you take dozens of medications a day, you’d likely be willing to try anything to help improve your quality of life. DBS could become a life saver for individuals with treatment resistant conditions due to its effectiveness, precision, and money-saving side effects. Individuals who receive this treatment may have tried other options that have left them with more damage than before, perhaps nerve cells have been damaged or they’ve been through multiple surgeries and are tired of being in recovery. Deep brain stimulation, post-surgery, is rather non-invasive. It doesn’t damage brain cells like past treatments may have. Once implanted and customized, patients may experience such an intense decrease in symptoms that they may find they can cut out many of the medications they’ve been taking for years, saving them copious amounts of money. The customization of DBS is another positive to this technique. It can be totally personalized to a person’s condition and symptoms and can be constantly monitored and tweaked to meet patient need. Although there are many positives, it is still brain surgery and therefore, may not be for everyone. Patients have to weigh not only the benefits, but the negative side effects of this treatment as well.

On top of everything they’ve already experienced while living with and treating a life-altering condition, brain surgery can be a very traumatic event for a patient. This surgery (amongst other brain surgeries) is also vastly more nerve-wracking because the patient needs to be awake and able to communicate with the neurosurgeon while it’s taking place. It also comes with a host of other side effects, such as, bleeding in the brain, seizures, headaches, confusion, stroke, or the possibility of needing the equipment replaced after time. The equipment used may make future imaging difficult as well, due to the metals and electronics it contains. Patients will likely need further imaging in their future if they’re living with a condition that requires it. The surgery is also expensive and results are not immediate. Just like with medications, it may take months to find the perfect “dose” and frequency of stimulation. (parkinsonsdisease.net, 2017) These negative side effects may be enough to make a patient reconsider deep brain stimulation as a treatment.

Currently, deep brain stimulation is FDA approved to treat only three conditions: Parkinson’s, essential tremors, and a condition call dystonia. These three are treated by electrical stimulation in the movement areas of the brain, as that is where the malfunction is occuring. (Lyons, 2011) However, there are quite a few conditions that neuroscientists are in the process of performing clinical studies for. These conditions vary in where the stimulation will be needed in the brain and also vary in effectiveness during these clinical trials. (Lyons, 2011)

Looking towards the future, it is quite possible that deep brain stimulation will become used for an even wider array of conditions/diseases. Neuroscientists like Mayo Clinic’s Kendall H. Lee, M.D., PhD., are working to discover other ways that this treatment can be used. On the Mayo Clinic website, there is a video of Lee describing the research they’re doing. He says, “So, in the case of Parkinson’s disease, for example, we’re very interested in neurotransmitter dopamine, and now there are some early studies, very early studies, although these are very preliminary, that perhaps in Parkinson’s disease that dopamine could be released. It is, still preliminary, but there are some data that are suggesting that. From that, people have now thought that perhaps by stimulating different areas of the brain, we could activate other neurotransmitter systems, or perhaps different neuro-circuits.” (Mayo Clinic, 2010)

By far, the single most telling sign that deep brain stimulation is an amazing technology, is watching videos of patients who have finally seen the effects that it has had on their condition. One 8 year old boy went from crawling on the ground due to his dystonia, to running down hallways full speed, finally able to control his body again. (Lozano, 2013) Seeing their faces, and watching the positive impact it has on these individuals’ lives, brings everything into perspective. Surgery is scary and dangerous, but, for these people, still worth it. As research moves forward, we will see more and more uses for this technique come to the surface, and if it can make one life easier, it will have been worth all of the research and trials. Moreover, as we collect more results from the studies of deep brain stimulation we may learn more about the brain itself and how doctors can play a part in assisting it when it malfunctions.

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