Extreme treatment for a serious disease 1: Parkinson's
"The tremors started in 1999. I remember pouring a glass of wine and my hand starting to shake. “What’s that?” my wife at the time asked. “Parkinson’s,” I joked. We laughed. I was only 43. It seemed funny. The shaking went away, but over the next few weeks I started using the computer mouse and eating with my left hand. I didn’t know it, but the Parkinson’s was affecting the fine motor control on my right side. It was subtle, but enough to make me more comfortable as a southpaw. “That’s odd,” I thought. “When did I become left-handed?”
This is a very interesting essay from a man who chose an extreme treatment for his early-onset Parkinson's. It's a bit long, but if you have time I think you'll find it very interesting. You can then post research you've found on deep brain stimulation.
35 comments:
Deep brain stimulation was first developed in France as a response to lobotomies that were once used, yet ineffective. Heat probes were once used and doctors would burn small regions of the human brain. In the case for this surfer, he had Parkinson's disease and the use of deep brain stimulation slender electrodes are implanted into the patient's brain that send small waves of electricity in the region that is causing the tremors and other side effects of Parkinson's. Usually for Parkinson's, the electrodes are threaded to the brain aiming for the subthalmic nucleus. The battery pack for the DBS is inserted in the chest and wires run along the back of the skull from the small portion the electrodes are connected to in the brain.
DBS devices can be programmed up to 60,000 different ways. It is important for the patient to control the device and also know exactly how to set it. Parkinson's is associated with a low level of dopamine, so when the patient turns on the DBS, small shock waves are sent throughout the brain in an effort to stimulate the area and reduce tremors.
Also, DBS's are not miracle workers. They do not cure Parkinson's but they do help it. There are many side effects of parkinson's that are not fixed by the device such as depression, low sexual drive and memory loss.
The remarkable thing about DBS's is that doctors and researchers have begun to use the device to treat other disorders, such as depression. Small electrodes are placed in the brain centers having to do with depression and there, the area is stimulated by the device. We can think of a DBS as a pacemaker for the brain. Just as we have learned about Pacemaker's for the heart, this tool is a step in research that may have serious effects that drugs control.
Here is more information on DBS:
http://www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_brain_stimulation.htm
I've found an article titled, "Parkinson's: How Deep Brain Stimulation affects Decision Making." This article details about how DBS offers relieve that others medicine cannot for the Parkinson's disease. The Deep Brain Stimulation affects a certain area of the brain known as the subthalamic nucleus. This region of the brain deals with decision-making. Another way to think about this region is when we are making a difficult decision between two or more choices, our most common response would be to ask for an extra minute to think about the conflict. The response that the STN sends, a neutral signal is interruppted by the DBS. The DBS has been actually fund to speed up the decision making process, a sign of impulsive decision making.
here is more information on the article dealing with DBS:
http://www.sciencedaily.com/releases/2007/10/071025143321.htm
Researchers have discovered that deep brain stimulation holds huge potential for helping disorders such as Parkinsons disease. This treatment was first developed in 1987 and has evolved ever since. The steady pulses of electricity that are sent through the brain kind of make a steady pacemaker for the brain. Its a very painstaking procedure but its worth it in the end. DBS is not a cure for Parkinson's patients, but it can help with their movement. I found this article very interesting. It goes into details about the ups and downs of the treatment know as deep brain stimulation. Follow this linnk to receive further information.
http://www.time.com/time/magazine/article/0,9171,1214939,00.html
Parkinson's disease erodes a person's ability to control their speech and movement. I found an article very similar to Professor Williams' essay, however it is from an impersonal standpoint. It explained that after so many medical treatments, doctors begin losing control over their patients and find that using Deep Brain Stimulation helps allow to further their patient's health. The author states, "It is believed that DBS disrupts abnormal firing patterns present in movement disorders at discrete points in this circuitry and replaces them with more regular patterns of firing.” I find it beneficial that western medicine is improving constantly.
http://www.sciencedaily.com/releases/2008/02/080213162623.htm
Deep brain stimulation is "a neurosurgical procedure to implant electrodes, or stimulators, into nuclei within the brain, especially for the treatment of movement disorders." DBS is used to treat patients with Parkinson's Disease, Essential Tremor, and even dystonia. In the article that I read, it stated that there are two different types of Parkinson's disease: patients who have tremor symptoms that have not been treatable with medication and patients who have treated their tremor with medication, but have severe motor fluctuations. DBS is a way to assist in treating Parkinson's Disease and other motor disorders to the best that they could, but it is not a guaranteed cure for those with the disorder.
http://www.neuro.jhmi.edu/dbs/
The benefits of deep brain stimulation are just now being realized in helping patients with neurologic disorders such as Parkinson's disease and other movement disorders like essential tremor. Johns Hopkins University is a leading medical center doing extensive work in this field as noted by Jessica Shin in the previous website.
Of interest, the company in the United States doing extensive research in this field using what is called "Activa Deep Brain Stimulation" is Medtronic. The benfits of DBS includes reduction of rigidity, bradykinesia, akinesia and involuntary tremors in a considerable number of patients. The website activadbs.com offers some insite into this treatment method. The medtronic website directs individuals interested in learning more information about the subject.
http://www.medtronic.com/neuro/parkinsons/activa_qa.html
I found that Massachusetts General Hospital in Boston has been doing extensive research on various surgeries for Parkinson's disease. The scientific explanation of using surgery to treat Parkinson's disease is extensively outlined in the article. Currently, deep brain stimulation is approved by the FDA only for use in the thalamus. However, "off label" treatments are being tried in different areas of the brain including surgical removal called palliodotomy. The longterm benefits of these techniques are still under investigation.
http://neurosurgery.mgh.harvard.edu/functional/PDsurgery.htm
Deep Brain Stimulation is used for some people who have Parkinson's disease. Researchers found that Deep brain stimulation cut about 50 percent depression symptoms and about half of those were treated. Deep brain stimulation is when surgery is done on the patient with Parkinson's Disease on the brain. Electrodes are placed into specific parts of the brain that has a malfunctioning problem. The electrodes then produce small electrical pulses that stop dysfunctional activity in the brain.
I think this is a pretty good way to treat not only Parkinson's disease, but other diseases as well. This could treat other disorders like Obsessive Compulsive Disorder or maybe Depression.
http://www.medicinenet.com/script/main/art.asp?articlekey=89052
Deep brain stimulation involves a brain pacemaker to be surgically implanted. The pacemaker sends impulses to certain places in the brain. This treatment not only has been used for Parkinson’s disease patients, like the one in the article, but other disorders as well such as dystonia which is a neurological movement disorder. The effects of deep brain stimulation are not reversible. Though it does not cure Parkinson’s disease, it helps manage some of the symptoms and helps improve patients’ life. You can find more information about deep brain stimulation on:
http://en.wikipedia.org/wiki/Deep_brain_stimulation
Deep brain stimulation is a highly experimental treatment for depression in which the brain is stimulated with electrical impulses in an attempt to change mood. As of now, deep brain stimulation has not been approved by the FDA for depression, but it has become the normal procedure for those with Parkinson's disease.
Though beneficial, there are some side effects to consider for those who wish to have this brain procedure. The common side effects and health complications associated with deep brain stimulation are bleeding of the brain, infection, delirium, unwanted mood changes, movement disorders, lightheadedness, and insomnia. For those who underwent this treatment for Parkinson's disease experienced side effects of panic attack, speech difficulty, movement problems, and even suicide.
Deep brain stimulation is a risky procedure and one who wishes to treat either Parkinson's or depression needs to weigh the pros and cons.
http://www.mayoclinic.com/health/deep-brain-stimulation/MH00114
Deep brain stimulation can be used to treat severe cases of depression, if medications and therapy fail. This treatment involves the stimulation of the brain with electrical impulses. Doing so, doctors hope to change the mood of the patient suffering from depression. Even though deep brain stimulation has become a fairly standard treatment for Parkinson's disease, it is still in the developing stages for treatment in Depression and has yet to become FDA approved.
Deep brain stimulation involves surgery on the brain and the chest, first to implant electrodes and then to implant a neurostimulator device. The neurostimulator device provides the patient with a customized dosage of electrical impulses controlled from outside the body. Since this procedure is still in its developing stages there are many known risks and side effects such as seizures and bleeding in the brain.
Although deep brain stimulation have been used on Parkinson's Disease patients and have proved to be successful in some cases, it is still a risky and evolving procedure for the treatment of depression and should only be used as last resort for life-threatening cases of depression.
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/28/AR2008042801544.html
Michael Frank, an assistant professor of psychology found out that DBS actually sped up the decision-making process (impulsive decision making). But he also found out that it prevents patients from learning from their mistakes--from the "negative outcomes of their choices." This is why patients develop habits like those of a gambler. People have shown that when they use DBS and medication to treat Parkinson's, it shows that they cause pathological gambling to some degree. This same study also showed similarities to consumer behavior (for more information on this, click link provided below). I think it's good/interesting how studies on diseases and treatments that many people have never heard of or know very little about can be more easily understood and explained by common terms and daily behavior such as gambling and consumer behavior. It definitely helped me to understand better!
http://www.medicalnewstoday.com/articles/86795.php
Although deep brain stimulation is mostly used for people suffering from movement disorders such as Parkinson's, this Washington Post article and this Medical News Today article discuss the use of deep brain stimulation for people who are severely depressed and cannot be cured by conventional means. Researchers have found that it has cut depression symptoms by up to 50% for approximately half of those treated.
DBS is a minimally-invasive surgery that consists of placing electrodes on areas of the brain that are perceived to be malfunctioning. These electrodes emit small electrical pulses that block dysfunctional activity. This new discovery will help people suffering from depression who have tried antidepressant drugs and even electroconvulsive (ECT) therapy but saw no results. Even the people who were treated by DBS but saw no results said they were willing to try it again. The fact that this procedure is so minimally-invasive is great news, as those who are usually skeptical of more extreme means of healing can now consider this option.
Deep brain stimulation, while seen to be affective in Parkinson's patients, has also been proven effective in helping patients with certain mood disorders such as depression. However, for patients with depression, deep brain stimulation should only be limited to use for people with severe and debilitating symptoms. The risks involved with deep brain stimulation are extensive. Some were discussed in the essay from wired.com but others include brain bleeding, unwanted mood changes (can worsen depression if the procedure goes off course), delirium, infection among others.
The deep brain stimulation has been proven effective in improving depression because it shocks the areas of the brain that are involved with mood and allows these areas to function normally again.
for more information on this: http://www.mayoclinic.com/health/deep-brain-stimulation/MH00114
A form of treating Parkinson's Disease is through deep brain stimulation. This surgical procedure has to deal with putting needles into the brain through tiny gaps created in the skull to pinpoint the location of the nucleus.In this stage og the surgery, the patient is unconscious. Once the nucleus is located, a permanent electrode is inserted. Here, the electrode is then connected to a pulse generator, which is placed in the chest cavity.
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11069
Deep brain stimulation seems like a prety radical treatment for parkinson's desaease but if it works, itd be well worth it. I personally would be more worried about shaving my head than the actual surgical procedure! Here is some information about deep brain stimulation and parkinson's diseas.
Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. DBS in select brain regions has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders such as chronic pain, Parkinson’s disease, tremor and dystonia.[1] Despite the long history of DBS,[2] its underlying principles and mechanisms are still not clear. DBS directly changes brain activity in a controlled manner, its effects are reversible (unlike those of lesioning techniques) and is one of only a few neurosurgical methods that allows blinded studies.
Parkinson's disease (also known as paralysis agitans) is a neurodegenerative disease whose primary symptoms are tremor, rigidity, bradykinesia and postural instability.[9] DBS does not cure Parkinson's, but it can help manage some of its symptoms and subsequently improve the patient’s quality of life.[10] At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications, or whose medications have severe side effects.[5] Its direct effect on the physiology of brain cells and neurotransmitters is currently debated, but by sending high frequency electrical impulses into specific areas of the brain it can mitigate symptoms[11] and/or directly diminish the side effects induced by Parkinsonian medications,[12] allowing a decrease in medications, or making a medication regimen more tolerable.
http://en.wikipedia.org/wiki/Deep_brain_stimulation#Parkinson.27s_disease
In some cases, instead of electroconvulsive therapy (ECT) where the entire brain is shocked from the outside, cases of severe depression and Parkinson's Disease are now being treated with a new radical operation called deep-brain stimulation. Stimulators implanted in the chest connected to wires in the brain send small doses of electricity to the part of the brain which is believed to regulate mood. This is comparable to pacemakers inserted in the chest to regulate heartbeat. A notable difference with this treatment is that DBS targets axons where the added voltage may increase the bandwidth of the axons, allowing them to carry more and more accurate information, helping to alleviate depression.
Several trials of this new treatment are underway at Emory University and the University of Toronto and it is estimated that fewer than 50 people have gone through the surgery. Results from the Toronto group have been impressive so far with four out of six patients showing significant improvement.
http://www.popsci.com/scitech/article/2007-09/happiness-warm-electrode
Deep brain stimulation is used to treat a variety of disabling neurological symptoms, the most common is parkisons disease and is only used when medication does not work. Before the procedure, a neurosurgeon will use magnetic resonance imaging or computed tomography scanning to identify where the exact target is within the brain where electrical nerve signals generate the Parkison's . After that the deep brain stimulation surgery is performed. It consists of three parts, the lead, the extension, and the neurostimulator. The lead is inserted through a small opening in the skull implanted in the brain. The extension is a wire that passes under the skin of the head, neck, and shoulder, and connects the lead to the neurostimulator. The neurostimulator is usually implanted under the skin near the collarbone. It works by blocking the block the electrical signals that cause Parkinson's disease symptoms. Electrical impulses from neurostimulator is carried along the up extension wire up to the brain brain.these impulses block the signals from the brain and unlike other precedure, this operation does not damage brain cells. More information can be learned athttp://www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_brain_stimulation.htm
Deep brain stimulation is not only a great treatment for Parkinson's but can also treat other problems. Along with treating a horrible disease like Parkison's, DBS can also alleviate other troubling symptoms, such as "Unilateral, Neuralgiform headache attacks with Conjuctival injection and Tearing" which is also known as SUNCT and can be translated to severe headaches that occur often during a day. In an article on MedicineNet, a study at Mayo Clinic on a 44 year old man was taken. This unfortunate individual suffered over 200 severe headaches on the right side of his brain a day and had been living this excruciating life ever since the young age of 14. Nothing could help him and he ended up being incapicitated for 9 years. After having Deep Brain Stimulation treatment in the ipsilateral hypothalamus (so the right of his brain because his headaches were on the right side), his headaches began to decrease gradually from 200 to 45 to 33 to 25. DBS made his life easier and functional. Although his headaches were not eliminated, DBS did help to reduce them a great deal.
Deep brain stimulation is not only a great treatment for Parkinson's but can also treat other problems. Along with treating a horrible disease like Parkison's, DBS can also alleviate other troubling symptoms, such as "Unilateral, Neuralgiform headache attacks with Conjuctival injection and Tearing" which is also known as SUNCT and can be translated to severe headaches that occur often during a day. In an article on MedicineNet, a study at Mayo Clinic on a 44 year old man was taken. This unfortunate individual suffered over 200 severe headaches on the right side of his brain a day and had been living this excruciating life ever since the young age of 14. Nothing could help him and he ended up being incapicitated for 9 years. After having Deep Brain Stimulation treatment in the ipsilateral hypothalamus (so the right of his brain because his headaches were on the right side), his headaches began to decrease gradually from 200 to 45 to 33 to 25. DBS made his life easier and functional. Although his headaches were not eliminated, DBS did help to reduce them a great deal.
http://www.medicinenet.com/script/main/art.asp?articlekey=88797
This is the link to my post on DBS curing severe headaches.
I found a really interesting website that describes a case of deep brain stimulation. On this website, it states that deep brain stimulation helped 19 out of 20 patients with Parkinson's disease, but there was one patient that resulted in transient acute depression when high-frequency stimulation was delivered to the left substantia nigra. The research on the patient in that case shows that the stimulation of the left part of the brain has a connection to depression. However when stimulation of the right brain was done, depression was not a result. In analyzing this information, it is evident that the two sides of the brain have different functions.
http://content.nejm.org/cgi/content/full/340/19/1476
From my researched, I found out that some people with Parkinson's disease had tremors or also known as dystonia. The tremors hindered those with parkinson's to not be able to function well and could not even pour themselves liquid. These tremors can be cured with deep brain stimulation. DBS is where they put electrical wires through the brain down to the collarbone area. This wire sends electrical impulses that can be turned off when sleeping and turned on for the day. It is interesting to know that this cures almost all the tremors and that the FDA even approved it and declared it safe. Even the bilateral DBS treatment was approved. Almost 2000 people with Parkinson's disease in the United States today have had DBS treatment and have benefited from it. It has proved to be harmless to the rest of the body and the brain as well and proved to only cure the tremors or the dystonia.
http://rarediseases.about.com/cs/movementdisorders/a/020902.htm
I forgot the URL. HEre it is.
http://www.mayoclinic.com/health/deep-brain-stimulation/MH00114
Interesting and disturbing at the same time, in my opinion. But then again, I'm happy for the guy... It's crazy how technologically advanced we have become [even if he states that it's a new science].
This same procedure is now being experimented to treat depression, although it is only under case studies at this point for it is not FDA approved. Same procedure, but because it's not the same as Parkinson's, it has to be treated differently on terms of which electrodes to deal with. I am also aware that depression not only deals with dopamine but with other neurotransmitters such as serotonin. The article doesn't cover this, so I can't be for sure, but I believe many of the recent depression drugs tamper with serotonin levels [which isn't mentioned in the article on Parkinson's Disease].DBS brings in similar side effects to depression patients as with the man in the article [although I don't know how a person can "report side effects of... suicide"].
DBS is not only used for Parkinson's disease but also for morbidly obese patients to reduce their appetite. An electrode in placed into the hypthalamus, the section of the brain which regulates essential body fluids and contains glucoreceptors, cells which detects gulcose levels in the body to regulate appetite.
Interestingly enough, some of the patients who underwent DBS reported to have reported to experience vivid memories. In other words, they would be able to see events which happened in the past.
Furthermore, patients who underwent DBS did better in memory tests.
The following link also contains links to other papers dealing with memory and neurophilosophy.
http://www.mindhacks.com/blog/2008/02/deep_brain_stimulati.html
I find it very fascinating they are able to perform deep brain stimulation with the patient conscious. However, it is also very scary, espcially in the situation where a problem of high probability can occur.
In my research of deep brain stimulation (DBS) I found that over 2,000 people with Parkinson's disease in the U.S. have had DBS systems implanted. For most people, DBS has relieved many symptoms and improved their ability to walk and do the activities of daily life. Researchers believe that as many as 15% of people with Parkinson's could benefit from DBS each year. So far, the risks seem acceptable; a study in 2000 reported that long-term use of DBS does not cause damage to the brain around the electrode.
http://rarediseases.about.com/cs/movementdisorders/a/020902.htm
If I had Parkinson's Disease I think I would seriously consider having the procedure done. Its seems to work for many Parkinson's victims. Hopefully I won't have to worry about it for a while.
Deep brain stimulation (DBS) is used to treat parkinson disease and essential tremor. The movement disorder of parkinson disease is the complex circuit within the brain loses regulation, thus certain part of the brain becomes overactive. The surgical treatment of this overactive portion of the brain can be treated by destructing part of it to balance the circuit. It can also be treated by electrically stimulating the same area. In DBS, electrodes are implanted in the brain to deliver a low and continuous current to the area. It is said that DBS has dramatically changed the lives of many patients. The patients are able to resume normal activities such as dressing and feeding themselves. Researchers have found that DBS can relieve chronic nerve related pain. The possible areas of study for DBS are in seizure disorders, multiple sclerosis, paralysis, obsessive-compulsive disorders, and depression.
Deep brain stimulation is used for extreme cases of Parkinson's and other neurological diseases.
Once the MRI scan has identified the target of the DBS, the surgeons have a general idea of where they need to open up the skull. During the first phase of surgery, the patient is sedated or given local anesthesia and electrodes are placed in the brain. The patient returns for the second phase of surgery, which takes place 3-7 days later. During the second phase, the patient is put under general anesthesia when the pulse generator (battery) is placed under the skin, near the collarbone. The battery becomes the source of the charges that go to the electrodes in the brain. With the electrodes surging to the brain and encourage the cells to start to release necessary chemicals.
Nevertheless, there are side-effects such as battery failure, infections, or the possibility of the wire moving. However, technology has advanced and side effects become less and less likely.
In many cases, the deep brain stimulation is a better alternative than no treatment at all.
http://www.neurosurgery.pitt.edu/imageguided/movement/stimulation.html
As tragic as it is, that's really a very interesting case. I can't imagine having to suddenly do normal everyday tasks, that I'd been accomplishing with ease for forty years, with my opposite hand. It's remarkable that it seemingly went unnoticed for some stretch of time.
Deep brain stimulation offers relief from the complications of Parkinson's disease patients, who can't find it through medications. However, this method of treatment often causes the patients to develop compulsive disorders. Check out the link for more information.
http://www.sciencedaily.com/releases/2007/10/071025143321.htm
As tragic as it is, that's really a very interesting case. I can't imagine having to suddenly do normal everyday tasks, that I'd been accomplishing with ease for forty years, with my opposite hand. It's remarkable that it seemingly went unnoticed for some stretch of time.
Deep brain stimulation offers relief from the complications of Parkinson's disease patients, who can't find it through medications. However, this method of treatment often causes the patients to develop compulsive disorders. Check out the link for more information.
http://www.sciencedaily.com/releases/2007/10/071025143321.htm
I found an example of a case in which DBS has been highly successful in treating Tourette's Syndrome. Tourette's Syndrome is a disorder marked by uncontrollable vocalisations and movement, which can be a source of social embarassment and isolation for many. In DBS, high frequency electrical signals are continuously sent out in an attempt to redress the shortfall that is causing the tremors or uncontrollable movement. Luckily, for Jeff Matovic, his symptoms disappeared within hours after the stimulator was turned on. This is a great success story because it means that DBS might just be the cure to Tourette's. It may be the ray of hope for those suffering from the disease for years.
http://news.bbc.co.uk/1/hi/health/3589395.stm
More on Tourettes
http://neurophilosophy.wordpress.com/2007/02/06/deep-brain-stimulation-for-tourettes-syndrome/
The article was incredible to read. I can't imagine being awake during that kind of serious procedure. The part that really struck me was when he talked about how they were "drilling in his skull, it didn't hurt but it was loud". Seems like it would be a bizarre and unique experience to be awake and being asked to more different parts of your body as doctors work on your brain.
http://www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_brain_stimulation.htm Here is an article that really breaks down deep brain stimulation. It makes it pretty dummy proof. I think what amazes me the most about this whole process is that it is long and involved and it still does not guarantee that parkinson's will go away. Many patients still have to take medications and deal with some side affects. So patients go through this entire procedure so they can reduce there symptoms. Wow
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