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Encyclopedia > Deep brain stimulation

In neurotechnology, 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 was approved by the Food and Drug Administration (FDA) in 1997 as a treatment for essential tremor and in April 2003 as a treatment for dystonia.[1] The FDA approved DBS for Parkinson's disease in 2002.[2] DBS may also alleviate symptoms in treatment-resistant clinical depression,[3] and has been used experimentally in the treatment of other conditions. While DBS is helpful for some patients, there is potential for serious complications and side effects. Neurotechnology is the set of tools that analyze and influence the human nervous system, especially the brain. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... Brain pacemakers are used to treat people who suffer from epilepsy, Parkinsons disease, clinical depression and other diseases. ... In animals the brain, or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for thought. ... The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food (humans and animal), dietary supplements, drugs (human and animal), cosmetics, medical devices (human and animal) and radiation emitting devices (including non-medical devices), biologics, and... 1997 (MCMXCVII) was a common year starting on Wednesday of the Gregorian calendar. ... 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder or sometimes called manic depression]) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ...

Contents

Components and placement

The deep brain stimulation system consists of three components: the implanted pulse generator (IPG), the lead, and the extension. The IPG is a battery powered neurostimulator encased in a titanium housing, which sends electrical pulses to the brain to interfere with neural activity at the target site. The lead is a coiled wire insulated in polyurethane with four platinum iridium electrodes, which is placed in one of three areas of the brain. The lead is connected to the IPG by the extension, an insulated wire that runs from the head, down the side of the neck, behind the ear to the IPG, which is placed subcutaneously below the clavicle or in some cases, the abdomen.[4] The IPG can be calibrated by a neurologist, nurse or trained technician to optimize symptom suppression and control side effects.[citation needed] Four double-A (AA) rechargeable batteries In science and technology, a battery is a device that stores chemical energy and makes it available in an electrical form. ... The nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and processes input from the senses, and initiates actions. ... A. A schematic view of an idealized action potential illustrates its various phases as the action potential passes a point on a cell membrane. ... A polyurethane is any polymer consisting of a chain of organic units joined by urethane links. ... General Name, Symbol, Number platinum, Pt, 78 Chemical series transition metals Group, Period, Block 10, 6, d Appearance grayish white Standard atomic weight 195. ... General Name, Symbol, Number iridium, Ir, 77 Chemical series transition metals Group, Period, Block 9, 6, d Appearance silvery white Atomic mass 192. ... Collarbone and collar bone redirect here. ... The human abdomen (from the Latin word meaning belly) is the part of the body between the pelvis and the thorax. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ... This article focuses on the education and regulation of nurses. ... A technician is generally someone in a technological field who has a relatively practical understanding of the general theoretical principles of that field, e. ...


DBS leads are placed in the brain according to the type of symptoms to be addressed. For essential tremor and Parkinsonian tremors, the lead is placed in the thalamus. For dystonia and symptoms associated with Parkinson's disease (rigidity, bradykinesia/akinesia and tremor), the lead may be placed in either the globus pallidus or subthalamic nucleus.[5] This article or section does not cite its references or sources. ... The onset of Parkinsons Disease characteristic tremor is often insidious, is usually pill rolling and can be timed as 4 to 6 alterations per second (4 to 6 Hz). ... For the computer game developer, see Thalamus Ltd. ... Dystonia (literally, abnormal muscle tone) is a generic term used to describe a neurological movement disorder involving involuntary, sustained muscle contractions. ... In mathematics, suppose C is a collection of mathematical objects (for instance sets or functions). ... In medicine (neurology), bradykinesia denotes slow movement (etymology: brady = slow, kinesia = movement). ... Akinesia is the inability to initiate movement, due to problems with selecting and activating motor programs in the brain. ... For the film see Tremors (film). ... The globus pallidus (Latin for pale body) is a sub-cortical structure in the brain. ... Coronal slices of human brain showing the basal ganglia, globus pallidus: external segment (GPe), subthalamic nucleus (STN), globus pallidus: internal segment (GPi), and substantia nigra (SN). ...


All three components are surgically implanted inside the body. The right side of the brain is stimulated to address symptoms on the left side of the body and vice versa.


Procedure

Insertion of electrode during parkinson surgery
Insertion of electrode during parkinson surgery

The procedure begins with preoperative identification of the neurosurgical target with computed tomography (CT), magnetic resonance imaging (MRI) or in earlier times ventriculography.[6] Image File history File links Information_icon. ... Image File history File links Download high-resolution version (787x1174, 751 KB) incertion of electrode during parkinson surgery Source: taken by user File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Neurosurgery Deep brain stimulation ... Image File history File links Download high-resolution version (787x1174, 751 KB) incertion of electrode during parkinson surgery Source: taken by user File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Neurosurgery Deep brain stimulation ... This article does not adequately cite its references or sources. ... Magnetic Resonance Image showing a median sagittal cross section through a human head. ...


During surgery, the patient is given local anesthesia and remains awake. A craniotomy is performed and a DBS lead is placed either unilaterally or bilaterally, depending on the patient's symptoms. Microelectrode recording may be used to more precisely locate the desired target within the brain. The IPG and extension are then implanted and connected to each lead. Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. ... A craniotomy is a surgical operation in which part of the skull (part of the cranium) is removed in order to access the brain. ... Unilateralism, (one+side-ism) is any doctrine or agenda that supports one-sided action. ... Bilateralism is a term referring to trade or political relations between two states. ...


Depending on the procedures of the medical facility, all components of the DBS system may not be implanted during a single surgery. After surgery is completed, the IPG is calibrated to maximize its effectiveness. Programming can take up to a year to achieve optimal settings.


Due to battery depletion, the IPG must be replaced—usually after three to five years, depending on the settings used. The entire unit is replaced to maintain an uncontaminated field within the body. Nevertheless, this is a minor surgical procedure involving only the shallow subclavicular pocket where the IPG resides. Remaining battery life may be reliably determined with a telemetric programmer so that arrangements can be made to replace the unit prior to battery failure.


Parkinson's disease

Parkinson's disease (also known as paralysis agitans) is a neurodegenerative disease whose primary symptoms are tremor, rigidity, bradykinesia and postural instability.[7] DBS does not cure Parkinson's, but it can help manage some of its symptoms and subsequently improve the patient’s quality of life.[8] At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications, or whose medications have severe side effects.[4] 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[9] and/or directly diminish the side effects induced by Parkinsonian medications,[10] allowing a decrease in medications, or making a medication regimen more tolerable. Neurodegenerative disease (Greek νέυρο-, néuro-, nerval and Latin dÄ“generāre, to decline or to worsen) is a condition in which cells of the brain and spinal cord are lost. ... For the film see Tremors (film). ... In mathematics, suppose C is a collection of mathematical objects (for instance sets or functions). ... In medicine (neurology), bradykinesia denotes slow movement (etymology: brady = slow, kinesia = movement). ... The well-being or quality of life of a population is an important concern in economics and political science. ... Neurotransmitters are chemicals that are used to relay, amplify and modulate electrical signals between a presynaptic and a postsynaptic neuron. ...


There are a few sites in the brain that can be targeted to achieve differing results, so each patient must be assessed individually, and based on their needs a site will be chosen. Traditionally, the two most common sites are the subthalamic nucleus (STN)and the globus pallidus interna (GPi), but other sites such as the caudal zona incerta and the pallidofugal fibers medial to the STN are being evaluated and showing promise.[11] Coronal slices of human brain showing the basal ganglia, globus pallidus: external segment (GPe), subthalamic nucleus (STN), globus pallidus: internal segment (GPi), and substantia nigra (SN). ... The zona incerta is a small region of gray matter that is part of the subthalamus. ...


DBS is approved in the United States by the Food and Drug Administration for the treatment of Parkinson's.[2] DBS carries the risks of major surgery, with a complication rate related to the experience of the surgical team.


Newer techniques, not using the stereotactic frame have been developed and are now widely used. This helps in the accuracy of the placement and the comfort of the patient.[citation needed]


Clinical depression

Researchers reported in 2005 that electrical stimulation of a small area of the frontal cortex brought about a "striking and sustained remission" in four out of six patients suffering from clinical depression, whose symptoms had previously been resistant to medication, psychotherapy and electroconvulsive therapy.[12] 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... Lightning strikes during a night-time thunderstorm. ... The frontal lobe is an area in the brains of vertebrates. ... Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder or sometimes called manic depression]) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... // Psychotherapy is a range of techniques based on dialogue, communication and behavior change and which are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). ... Electroconvulsive therapy (ECT), also known as electroshock, is a psychiatric treatment in which seizures are induced by passing electricity through the brain of an anaesthetised patient. ...


Using brain imaging, the researchers noticed that activity in the subgenual cingulate region (SCR or Brodmann area 25) — the lowest part of a band of tissue that runs along the midline of the brain — seemed to correlate with symptoms of sadness and depression. They implanted electrodes into six patients while they were locally anesthetised, but alert. While the current was switched on, four of the patients reported feeling a black cloud lifting, and became more alert and interested in their environments. The changes reversed when the current was switched off.[12] Imaging refers to the science of obtaining pictures or more complicated spatial representations, such as animations or 3-D computer graphics models, from physical things. ... // Human Brodmann area 25 (BA25) is an area in the cerebral cortex of the brain and delineated based on its cytoarchitectonic characteristics. ... In animals the brain, or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for thought. ... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ...


The effects of continuous SCR stimulation have produced sustained remission from depression in the four patients for six months. When reporting the results, the team did caution that the trial was so small that the findings must be considered only provisional.[12] Remission is the state of absence of disease activity in patients with known chronic illness. ...


Another hypothetically interesting site for DBS in depression is the Nucleus Accumbens [13], because a prominent clinical feature of depression is anhedonia—the inability to experience pleasure from previously pleasurable activities—and because there is clear evidence of dysfunctions of the reward system in depression. Three patients suffering from extremely resistant forms of depression, who did not respond to pharmacotherapy, psychotherapy, and electroconvulsive therapy, were implanted with bilateral DBS electrodes in the nucleus accumbens. Clinical ratings improved in all patients when the stimulator was on, and worsened in all when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Using FDG-PET, significant changes in brain metabolism as a function of the stimulation in fronto–striatal networks were observed. No unwanted effects of DBS other than those directly related to the surgical procedure (eg pain at sites of implantation) were observed. [14]. Look up depression in Wiktionary, the free dictionary. ... In psychology, anhedonia is a patients inability to experience pleasure from normally pleasurable life events such as eating, exercise, and social/sexual interactions. ...


Dysfunctions of the reward system—in which the nucleus accumbens is a key structure—are implicated in the neurobiology of major depression and might be responsible for impaired reward processing, as evidenced by the symptom of anhedonia. These very preliminary findings suggest that DBS to the nucleus accumbens might be another hypothesis-guided approach for refractory major depression. A reward is something that an animal will work to obtain, for example, food. ... The nucleus accumbens (NAcc), also known as the accumbens nucleus or as the nucleus accumbens septi (Latin for nucleus leaning against the septum), is a collection of neurons located where the head of the caudate and the anterior portion of the putamen meet just lateral to the septum pellucidum. ... Look up depression in Wiktionary, the free dictionary. ... In psychology, anhedonia is a patients inability to experience pleasure from normally pleasurable life events such as eating, exercise, and social/sexual interactions. ... The nucleus accumbens (NAcc), also known as the accumbens nucleus or as the nucleus accumbens septi (Latin for nucleus leaning against the septum), is a collection of neurons located where the head of the caudate and the anterior portion of the putamen meet just lateral to the septum pellucidum. ...


Tourette syndrome

Deep brain stimulation has been used experimentally in treating a few patients with severe Tourette syndrome. Despite widely publicized early successes, DBS remains a highly experimental procedure for the treatment of Tourette's, and more study is needed to determine whether long term benefits outweigh the risk.[15] The procedure is well tolerated, but complications include "short battery life, abrupt symptom worsening upon cessation of stimulation, hypomanic or manic conversion, and the significant time and effort involved in optimizing stimulation parameters".[16] As of 2006, there were five published reports of DBS in patients with TS; all experienced reduction in tics and the disappearance of obsessive-compulsive behaviors. "Only patients with severe, debilitating, and treatment-refractory illness should be considered; while those with severe personality disorders and substance abuse problems should be excluded."[16] There may be serious short- and long-term risks associated with DBS in persons with head and neck tics. The procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive considering less robust effects of this surgery seen in the Netherlands. Tourette's is more common in pediatric populations, tending to remit in adulthood, so this would not generally be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular patient. Due to concern over the use of DBS in the treatment of Tourette syndrome, the Tourette Syndrome Association convened a group of experts to develop recommendations guiding the use and potential clinical trials of DBS for TS.[17] Tourette syndrome (also called Tourettes syndrome, Tourettes disorder, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these... Experimental Related to experiment it is refered to ideas or techniques not yet stablished or finalized involving innovation. ... A tic is a repetitive, stereotyped, nonrhythmic, involuntary movement (motor tic) or sound (phonic tic). ... Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants and children. ... Tourette syndrome (also Tourettes syndrome or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. ...


Other clinical applications

DBS has been used in the treatment of obsessive-compulsive disorder,[18] phantom limb pain,[19] and cluster headaches.[citation needed] Although the clinical efficacy is not questioned, the mechanisms by which DBS works is still debated.[20] Long-term clinical observation has shown that the mechanism is not due to a progressive lesion, given that interruption of stimulation reverses its effects.[20] Results of DBS in dystonia patients, where positive effects often appear gradually over a period of weeks to months, indicate a role of functional reorganization in at least some cases.[21] The procedure is being tested for effectiveness in patients with severe epilepsy.[22] The gate control theory of pain of Ron Melzack and Patrick Wall arises from evolutionary psychology. ... Cluster headaches are rare headaches that occur in groups or clusters. ... A lesion is a non-specific term referring to abnormal tissue in the body. ...


Potential complications and side effects

While DBS is helpful for some patients, there is also the potential for neuropsychiatric side effects. Reports in the literature describe the possibility of apathy, hallucinations, compulsive gambling, hypersexuality, cognitive dysfunction, and depression. However these may be temporary and related to correct placement and calibration of the stimulator and so are potentially reversible.[23] A recent trial of 99 Parkinson's patients who had undergone DBS suggested a decline in executive functions relative to patients who had not undergone DBS, including problems with word generation, attention and learning. About 9% of patients had "psychiatric events", which ranged in severity from a relapse in voyeurism to a suicide attempt. Most patients in this trial reported an improvement in their quality of life following DBS, and there was an improvement in their physical functioning.[24] Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. ... Apathy is a psychological term for a state of indifference — where an individual is unresponsive or indifferent to aspects of emotional, social, or physical life. ... A hallucination is a false sensory perception in the absence of an external stimulus, as distinct from an illusion, which is a misperception of an external stimulus. ... Compulsive gambling is an urge or addiction to gamble despite harmful negative consequences or a desire to stop. ... Hypersexuality is a desire for human sexual behavior at levels high enough to be considered clinically significant. ... Look up Cognition in Wiktionary, the free dictionary. ... Clinical depression (also called major depressive disorder, or sometimes unipolar when compared with bipolar disorder or sometimes called manic depression]) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... The executive system is a theorised cognitive system in psychology that controls and manages other cognitive processes. ... Voyeurism is a practice in which an individual derives sexual pleasure from observing other people. ...


Because the brain moves slightly during surgery there is the possibility that the electrodes can become dislodged. This may cause more profound complications such as personality changes, but electrode misplacement is relatively easy to identify using CT or MRI. There may also be complications of surgery, such as bleeding within the brain. This article does not adequately cite its references or sources. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ...


There is a 2% risk of bleeding in the brain which can lead to a stroke. The stroke could result in weakness, intellectual impairment, or death. There is a 4% risk of infection: not life threatening but necessitating immediate removal of the DBS system;[citation needed] after the infection recedes. a new one may placed. A stroke, also known as cerebrovascular accident (CVA),[1] is an acute neurological injury in which the blood supply to a part of the brain is interrupted. ...


After surgery:

  • swelling of the brain tissue is normal
  • mild disorientation, sleepiness
  • follow up after 2-4 weeks to remove sutures, turn on the neurostimulator and program it

See also

Insertion of an electrode during neurosurgery for Parkinsons disease. ... Stereotactic surgery or stereotaxy is a minimally-invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation (removal), biopsy, lesion, injection, stimulation, implantation, radiosurgery etc. ... Psychosurgery is a term for surgeries of the brain involving procedures that modulate the performance of the brain, and thus effect changes in cognition, with the intent to treat or alleviate severe mental illness. ... Neuroprosthetics is an area of neuroscience concerned with neural prostheses, developing artificial devices to replace or improve the function of an impaired nervous system. ... Brain implants, often referred to as neural implants, are technological devices that connect directly to a biological subjects brain - usually placed on the surface of the brain, or attached to the brains cortex. ... Vagus nerve stimulation (VNS) is an invasive medical procedure used as an adjunctive treatment for intractable epilepsy and clinical depression. ...

Notes

  1. ^ 'Brain pacemaker' treats dystonia. KNBC TV, April 22, 2003. Retrieved October 18, 2006.
  2. ^ a b U.S. Department of Health and Human Services.FDA APPROVES IMPLANTED BRAIN STIMULATOR TO CONTROL TREMORS. Retrieved October 18, 2006.
  3. ^ Brain stimulation may treat resistant depression. CTV.ca, March 1, 2005. Retrieved October 18, 2006.
  4. ^ a b National Institute of Neurological Disorders and Stroke. Deep brain stimulation for Parkinson's Disease information page. Retrieved 23 November 2006.
  5. ^ Deep brain stimulation. Surgery Encyclopedia. Retrieved January 25, 2007.
  6. ^ Gildenberg and Tasker (1998), Part 4, pp. 879-1217
  7. ^ Ropper (2005), p. 916
  8. ^ Kleiner-Fisman G, Herzog J, Fisman DN, et al. "Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes." Mov Disord. 2006 Jun;21 Suppl 14:S290-304 PMID 16892449
  9. ^ Moro E, Lang AE. "Criteria for deep-brain stimulation in Parkinson's disease: review and analysis". Expert Review of Neurotherapeutics. 2006 Nov;6(11):1695-705. PMID 17144783
  10. ^ Apetauerova D, Ryan RK, Ro SI, Arle J, et al. "End of day dyskinesia in advanced Parkinson's disease can be eliminated by bilateral subthalamic nucleus or globus pallidus deep brain stimulation". Movement Disorders. 2006 Aug;21(8):1277-9. PMID 16637040
  11. ^ Plaha P, Ben-Shlomo Y, Patel NK, Gill SS. "Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral parkinsonism". Brain (2006). 129, 1732-1747 PMID 16720681
  12. ^ a b c Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH. Deep brain stimulation for treatment-resistant depression. Neuron. 2005 Mar 3;45(5):651-60. PMID 15748841.
  13. ^ Schlaepfer TE, Lieb K. Deep brain stimulation for treatment of refractory depression. Lancet. 2005 Oct 22-28;366(9495):1420-2. PMID 16243078.
  14. ^ Schlaepfer TE, Cohen MX, Frick C, Kosel M, Brodesser D, Axmacher N, Joe AY, Kreft M, Lenartz D, Sturm V. Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression. Neuropsychopharmacology. 2007 Apr 11; [Epub ahead of print]. PMID 17429407.
  15. ^ Tourette Syndrome Association. Statement on DBS. Retrieved October 16, 2006.
  16. ^ a b Malone DA Jr, Pandya MM. Behavioral neurosurgery. Adv Neurol. 2006;99:241-7. PMID 16536372
  17. ^ Mink JW, Walkup J, Frey KA, et al. Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord. 2006 Nov;21(11):1831-8. PMID 16991144
  18. ^ Nuttin B, Cosyns P, Demeulemeester H, Gybels J, Meyerson B (1999) Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999 Oct 30;354(9189):1526 PMID 10551504
  19. ^ Kringelbach, Morten L. et al. (2007). "Deep brain stimulation for chronic pain investigated with magnetoencephalography". Neuroreport, 18(3), pp. 223-228.
  20. ^ a b Benabid AL, Wallace B, Mitrofanis J, Xia R, Piallat B, Chabardes S, Berger F. (2005) A putative generalized model of the effects and mechanism of action of high frequency electrical stimulation of the central nervous system. Acta Neurol Belg. 2005 Sep;105(3):149-57. PMID 16255153
  21. ^ Krauss JK (2002). "Deep brain stimulation for dystonia in adults. Overview and developments". Stereotactic and Functional Neurosurgery 78 (3-4): 168-182. PMID 12652041. 
  22. ^ Velasco F, Velasco M, Velasco AL, Jimenez F, Marquez I, Rise M. Electrical stimulation of the centromedian thalamic nucleus in control of seizures: long-term studies. Epilepsia 36: 63-71, 1995. PMID 8001511
  23. ^ Burn D, Troster A (2004). "Neuropsychiatric Complications of Medical and Surgical Therapies for Parkinson's Disease.". Journal of Geriatric Psychiatry and Neurology 17 (3): 172-180. PMID 15312281. 
  24. ^ Smeding H, Speelman J, Koning-Haanstra M, et al (2006). "Neuropsychological effects of bilateral STN stimulation in Parkinson disease: A controlled study". Neurology 66 (12): 1830-1836. PMID 16801645. 

The National Institute of Neurological Disorders and Stroke is a part of the U.S. National Institutes of Health. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ...

References

  • Gildenberg, Philip L. and Tasker, Ronald R. Textbook of stereotactic and functional neurosurgery, McGraw-Hill Publishing, 1998.
  • McIntyre CC, Grill WM (2000) Selective microstimulation of central nervous system neurons. Annals of Biomedical Engineering 38:219-233. PMID 10784087
  • McIntyre CC, Grill WM, Sherman DL, Thakor NV (2004) Cellular effects of deep brain stimulation: model-based analysis of activation and inhibition. Journal of Neurophysiology 91:1457–1469. PMID 14668299
  • Ropper, Allan H; Brown, Robert H. Adams and Victor's Principles of Neurology (8th Edition), McGraw-Hill Medical Publishing, 2005. ISBN 007141620X

External links

  • Deep brain stimulation for movement disorders
  • Therapeutic Neuromodulation Weblog

  Results from FactBites:
 
Deep Brain Stimulation (1652 words)
Deep brain stimulation (DBS) in adults is a one- or two-stage procedure under both local and general anesthesia.
Deep brain stimulation does not usually improve the "on" state (the patients best condition), but hopes to improve the patient when they are in their worst state.
The stimulators can be programmed in many different ways (the voltage, the frequency with which the stimulus is delivered to the brain, the length of each stimulus, and the shape of the stimulus and region that it influences the brain cells) and each patient may be different.
What is DBS? (711 words)
Deep brain stimulation (DBS) is a way to inactivate the thalamus, the subthalamic nucleus, or globus pallidus without purposefully destroying the brain.
Deep brain stimulation of the subthalamic nucleus is effective for all major symptoms of Parkinson's disease, such as tremor, slowness of movement, rigidity, and problems with walking and balance.
Deep brain stimulation of the globus pallidus is effective for a wide range of Parkinson's symptoms.
  More results at FactBites »

 
 

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