![]() ![]() ![]() by subsets of symptoms or biological measurements such as MRI scans), may also help to identify optimal DBS configurations on a more personalized basis. The ability to implement patient-specific stimulation parameters is a major strength of DBS therapy, and better patient categorization methods (e.g. New targets and stimulation patterns are actively being tested, and it is exceedingly probable that optimal parameters have not yet been worked out. This is not to say that DBS therapy does not have the potential to work for a greater percentage of patients, or generate larger symptom reductions in responders. Available data suggests that about half of the patients respond well to this therapy. At present, most is known about the efficacy of DBS for OCD and treatment-resistant depression, which often target emotional/limbic structures such as the nucleus accumbens. The future of neuropsychiatric DBS therapy is bright. Indirect, predictive measures of DBS efficacy have been reported, including smiling and laughter in OCD patients. This level of clinical feedback cannot be so readily provided in DBS surgery for neuropsychiatric diseases, where symptom alleviation is observed on a timescale of weeks or months, not seconds. Similarly, stimulation parameters can be readily altered to optimize therapeutic efficacy. With optimal electrode positioning, the motor symptoms in a Parkinson's patient may be instantaneously alleviated by DBS. However, by being awake, he could provide feedback about how the DBS stimulation tests were working, guiding the final electrode placement deep in the brain. Although there are no pain receptors in brain, this was surely an uncomfortable experience. When I shadowed a DBS electrode implantation surgery in a Parkinson's Disease patient, I noticed that he was kept awake (only lightly sedated) throughout the entire procedure. One of the major associated hurdles concerns the identification of optimal therapeutic targets and stimulation parameters (e.g., voltage and frequency). The challenges associated with DBS therapy are not trivial, particularly for neuropsychiatric diseases. In 2009, the Food and Drug Administration (FDA) approved the standard clinical use of DBS therapy in treatment-refractory OCD patients, under a Humanitarian Device Exemption Act.Ĭhallenges and Opportunities for Neuropsychiatric DBS Therapy ![]() Clinical trials for neuropsychiatric DBS therapy have exploded, with a large number of brain targets and diseases under investigation. According to one patient, the decrease in OCD symptoms was even more satisfying than the alleviation of Parkinson's symptoms.Īlthough psychosurgical approaches have a long and contentious history in neuropsychiatry, reports such as this one rekindled enthusiasm for surgical interventions in otherwise treatment-resistant psychiatric patients. Mallet's patients were unable to alleviate their OCD symptoms through medication and psychotherapy, but after using DBS to treat their Parkinson's Disease, the stimulation came with an unexpected and much-desired side effect-alleviation of their OCD symptoms. But in a substantial number of cases, these therapies are ineffective. Standard treatments for OCD include medication and psychotherapy, which generally work well together to treat disease symptoms. OCD is characterized by recurring, unwanted obsessions and compulsions (e.g., excessive hand-washing, other ritualistic behaviors), symptoms that can be incredibly debilitating and prevent many sufferers from engaging in everyday tasks. In addition to their Parkinson's, these patients suffered from a neuropsychiatric disease termed Obsessive-Compulsive Disorder (OCD). If the therapy doesn't work, or side effects are intolerable, clinicians can try to adjust the stimulation parameters, or as a last step, remove the electrodes.Īn early hint that DBS therapy would be useful in treating other types of brain disorders came in a small case report published in 2002 by Mallett and colleagues, describing two patients that received DBS for Parkinson's Disease. This may suggest that DBS acts to provide a "functional lesion" in brain circuitry, with the added benefits of being reversible and modifiable. Although the mechanisms of action are poorly understood, DBS therapy works well when targeted to brain regions in which surgical lesions are also effective. In Parkinson's Disease, the effects of DBS can be dramatic and immediate-resting tremors (shakiness at rest) dissolve, rigid muscles loosen, and many more benefits may be immediately observed. With this therapy, high frequency electrical stimulation is chronically delivered to a target brain region, powered by a battery source implanted near the patient's clavicle. DBS is an increasingly well-utilized therapeutic tool for many neurological diseases, predominantly movement disorders. ![]()
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