Deep Brain Stimulation for Movement Disorders

Abstract

Deep brain stimulation (DBS) is an implanted electrical device that modulates specific targets in the brain resulting in symptomatic improvement in a particular neurologic disease, most commonly a movement disorder. It is preferred over previously used lesioning procedures due to its reversibility, adjustability, and ability to be used bilaterally with a good safety profile. Risks of DBS include intracranial bleeding, infection, malposition, and hardware issues, such migration, disconnection, or malfunction, but the risk of each of these complications is low-generally ≤ 5% at experienced, large-volume centers. It has been used widely in essential tremor, Parkinson's disease, and dystonia when medical treatment becomes ineffective, intolerable owing to side effects, or causes motor complications. Brain targets implanted include the thalamus (most commonly for essential tremor), subthalamic nucleus (most commonly for Parkinson's disease), and globus pallidus (Parkinson's disease and dystonia), although new targets are currently being explored. Future developments include brain electrodes that can steer current directionally and systems capable of "closed loop" stimulation, with systems that can record and interpret regional brain activity and modify stimulation parameters in a clinically meaningful way. New, image-guided implantation techniques may have advantages over traditional DBS surgery.

Decoding gripping force based on local field potentials recorded from subthalamic nucleus in humans

“…Our findings suggest that the STN LFP could provide a high-performance control signal for BMI driven neuroprosthetic grasping in paralysed patients, leveraging advances in surgery for deep brain stimulation which has now become a relatively safe procedure (Larson, 2014). Surgical subcortical targets, such as the STN and globus pallidus (GPi), are involved in motor planning and execution.…”

Neuronal correlates of depression

“…Deep brain stimulation (DBS) is a well-accepted procedure for the treatment of movement disorders such as Parkinson’s disease [156]. Recent groundbreaking studies have shown that DBS, which involves delivery of focal electrical current to specific neural structures within the brain, rapidly alleviates symptoms of depression [9, 10].…”

Functional Neurosurgery

“…Patients with longstanding PD may have autonomic dysfunction, impaired respiratory reserve, sleep apnea, and increased risk for aspiration. 10 Autonomic dysfunction and levodopa therapy may lead to orthostatic hypotension.…”