History, Applications, and Mechanisms of Deep Brain Stimulation

JAMA neurology 02/2013; 70(2):163-71. DOI: 10.1001/2013.jamaneurol.45
Source: PubMed


Deep brain stimulation (DBS) is an effective surgical treatment for medication-refractory hypokinetic and hyperkinetic movement disorders, and it is being explored for a variety of other neurological and psychiatric diseases. Deep brain stimulation has been Food and Drug Administration-approved for essential tremor and Parkinson disease and has a humanitarian device exemption for dystonia and obsessive-compulsive disorder. Neurostimulation is the fruit of decades of both technical and scientific advances in the field of basic neuroscience and functional neurosurgery. Despite the clinical success of DBS, the therapeutic mechanism of DBS remains under debate. Our objective is to provide a comprehensive review of DBS focusing on movement disorders, including the historical evolution of the technique, applications and outcomes with an overview of the most pertinent literature, current views on mechanisms of stimulation, and description of hardware and programming techniques. We conclude with a discussion of future developments in neurostimulation.

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    • "It is thought that DBS regularizes neuronal patterns preventing the transmission of pathologic bursting and oscillatory activity in the brain. This results in improved processing of the sensomotor information and alleviation of motor symptoms (Miocinovic et al., 2013). Often there is a significant reduction in the daily levodopa dose, when STN is stimulated (Benabid et al., 2009; Malhado-Chang et al., 2008). "
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    ABSTRACT: Electromyography (EMG) and acceleration (ACC) measurements are potential methods for quantifying efficacy of deep brain stimulation (DBS) treatment in Parkinson's disease (PD). The treatment efficacy depends on the settings of DBS parameters (pulse amplitude, frequency and width). This study quantified, if EMG and ACC signal features differ between different DBS settings and if DBS effect is unequal between different muscles. EMGs were measured from biceps brachii (BB) and tibialis anterior (TA) muscles of 13 PD patients. ACCs were measured from wrists. Measurements were performed during seven different settings of DBS and analyzed using methods based on spectral analysis, signal morphology and nonlinear dynamics. The results showed significant within-subject differences in the EMG signal kurtosis, correlation dimension, recurrence rate and EMG-ACC coherence between different DBS settings for BB but not for TA muscles. Correlations between EMG feature values and clinical rest tremor and rigidity scores were weak but significant. Surface EMG features differed between different DBS settings and DBS effect was unequal between upper and lower limb muscles. EMG changes pointed to previously defined optimal settings in most of patients, which should be quantified even more deeply in the upcoming studies. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 02/2015; DOI:10.1016/j.clinph.2015.01.021 · 3.10 Impact Factor
    • "It involves the stereotactic implantation of electrodes in neuroanatomical targets where stimulation is applied via a stimulator device implanted subcutaneously (Tye et al., 2009). DBS provides a focal electrical network modulation, affecting several brain circuits of interest for neurosurgery, neurology and psychiatry involving movement, neurosensitive, neurobehavioral , cognitive, and psychiatric disorders (Dallapiazza et al., 2014; Miocinovic et al., 2013). When compared to previous ablative neurosurgical procedures such as capsulotomy or cingulotomy, DBS is considered non-destructive, reversible, and adjustable (Greenberg et al., 2008). "
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    ABSTRACT: Despite a wide variety of therapeutic interventions for major depressive disorder (MDD), treatment resistant depression (TRD) remains to be prevalent and troublesome in clinical practice. In recent years, deep brain stimulation (DBS) has emerged as an alternative for individuals suffering from TRD not responding to combining antidepressants, multiple adjunctive strategies and electroconvulsive therapy (ECT). Although the best site for TRD-DBS is still unclear, pilot data suggests that the medial forebrain bundle (MFB) might be a key target to accomplish therapeutic efficacy in TRD patients. To explore the anatomic, electrophysiologic, neurocognitive and treatment data supporting the MFB as a target for TRD-DBS. The MFB connects multiple targets involved in motivated behavior, mood regulation and antidepressant response. Specific phenomenology associated with TRD can be linked specifically to the superolateral branch (sl) of the MFB (slMFB). TRD patients who received DBS-slMFB reported high response/remission rates with an improvement in functioning and no significant adverse outcomes in their physical health or neurocognitive performance. Discussion The slMFB is an essential component of a network of structural and functional pathways connecting different areas possibly involved in the pathogenesis of mood disorders. Therefore, the slMFB should be considered as an exciting therapeutic target for DBS therapy to achieve a sustained relief in TRD patients. There is an urgent need for clinical trials exploring DBS-slMFB in TRD. Further efforts should pursue measuring baseline pro-inflammatory cytokines, oxidative stress, and cognition as possible biomarkers of DBS-slMFB response in order to aid clinicians in better patient selection. Copyright © 2014 Elsevier Inc. All rights reserved.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 12/2014; 58. DOI:10.1016/j.pnpbp.2014.12.003 · 3.69 Impact Factor
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    • "e waiting time between adjustments can influence when different therapeutic responses can be observed , and these responses also vary between disor - ders ( e . g . , Tremor is nearly immediate , whereas depression could take several weeks to observe the effect of a disorder ) ( Velasco et al . , 2007 ; Ricchi et al . , 2012 ; Min et al . , 2013 ; Miocinovic et al . , 2013 ) . Therefore , it is necessary to implement DBS con - trol strategies that can adjust stimulation parameters in real - time according to quantifiable and objective neurochemical , physio - logical , and behavioral changes while reducing the frequency of clinical interventions . However , before such control strategies can be implemente"
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    ABSTRACT: Current strategies for optimizing deep brain stimulation (DBS) therapy involve multiple postoperative visits. During each visit, stimulation parameters are adjusted until desired therapeutic effects are achieved and adverse effects are minimized. However, the efficacy of these therapeutic parameters may decline with time due at least in part to disease progression, interactions between the host environment and the electrode, and lead migration. As such, development of closed-loop control systems that can respond to changing neurochemical environments, tailoring DBS therapy to individual patients, is paramount for improving the therapeutic efficacy of DBS. Evidence obtained using electrophysiology and imaging techniques in both animals and humans suggests that DBS works by modulating neural network activity. Recently, animal studies have shown that stimulation-evoked changes in neurotransmitter release that mirror normal physiology are associated with the therapeutic benefits of DBS. Therefore, to fully understand the neurophysiology of DBS and optimize its efficacy, it may be necessary to look beyond conventional electrophysiological analyses and characterize the neurochemical effects of therapeutic and non-therapeutic stimulation. By combining electrochemical monitoring and mathematical modeling techniques, we can potentially replace the trial-and-error process used in clinical programming with deterministic approaches that help attain optimal and stable neurochemical profiles. In this manuscript, we summarize the current understanding of electrophysiological and electrochemical processing for control of neuromodulation therapies. Additionally, we describe a proof-of-principle closed-loop controller that characterizes DBS-evoked dopamine changes to adjust stimulation parameters in a rodent model of DBS. The work described herein represents the initial steps toward achieving a "smart" neuroprosthetic system for treatment of neurologic and psychiatric disorders.
    Frontiers in Neuroscience 06/2014; 8(8):169. DOI:10.3389/fnins.2014.00169 · 3.66 Impact Factor
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