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December 5, 2011

What will they think of next?


Who knew? In the 1960's up until the 1970's ablative stereotactic surgery was used to treat neurologic disorders and neuropsychiatric illness. This treatment was largely abandoned after the 70's due to the development of highly effective drugs to treat these problems, for example, "Levodopa" to combat Parkinson's disorder. Today there seems to be a virtual renaissance of similar techniques used to help those suffering.

The technique being employed uses high-frequency electrical deep brain stimulation (DBS) on specific targets to negate some disorders. Compared to the traditional ablative stereotactic surgery, which consists of lesions and very invasive brain surgery (irreversible), DBS is much less invasive in some respects. By applying high-frequency electrical stimulation to specific brain structures a similar (but different) effect of a lesion is essentially observed. Ever since this technique's rise in popularity (starting in the 1990's) people have the option of a "less permanent". These electrical pulses are delivered by electrodes chronically implanted into a persons brain at specific regions. The exact mechanism of action for DBS still isn't fully understood and clear, but the affects and benefits to patients are both lasting and clear.

Some of the diseases mentioned in the article include Parkinson's, Tourettes syndrome, obsessive compulsive disorder and depression. Patients receiving DBS to treat Tourettes syndrome had a >70% decrease of vocal or motor tics with disappearance of sensory urges. 35-70% of patients receiving DBS to treat OCD were benefitted by a significant reduction in obsessive and compulsive thoughts.

In my opinion, and it seems to be the case with most neurosurgical operations, DBS is the latest and greatest treatment available. Anytime patients can avoid a permanent/irreversible effect such as a lesion the better. My reasoning behind is vast. For example if a patient is suffering from body dissociation disorder and doesn't identify with their right arm and right leg and wants to have these two limbs removed. This persons could amputate these limbs without fully understanding the long term consequences involved or even without any benefit mentally. Or perhaps, the doctor could try a different technique, such as lesioning a brain region located using fMRI thought to be triggering body dissociation disorder. There is a chance the lesion might not properly treat the disorder or not treat it at all. Also the lesion may impair the individual in a more negative way in the long run, and since lesions are practically irreversible, the person is worse off. If DBS was used (tmi could be used as a pre-emptive mapping tool) the patient could be treated for their disorder in a non permanent way and avoid negative, unforeseen, long term issues.

I'm not entirely sure how invasive DBS is but the article made it out to be much less invasive as previous surgeries. Which to me makes sense since over time medical practices should become more and more efficient. Something haunts me about the fact little is truly known and fully understood about DBS and TMI. Little red flags go up in my head every time that fact is mentioned. Whether or not it is effective and beneficial I would prefer to know exactly why it is effective and beneficial before doctors implanted electrodes in my brain to deliver pulses of high-frequency electricity. This honestly sounds like something out of a science fiction story but the real freaky part is it seems to actually work. The big question is: Would you ever have DBS performed on yourself? My answer is yes.

http://www.sciencedirect.com/science/article/pii/S089662730600729X
Posted by      Dylan R. at 5:42 PM MST

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