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Deep Brain Stimulation
From Mary Kugler,Your Guide to Rare / Orphan Diseases.

Decreases dystonia, tremors
Imagine that your head and neck twitch uncontrollably, or seize up
painfully, or that your left arm starts shaking for no reason. Dystonia
refers to a group of complex muscle disorders that involve involuntary
twisting, repetitive movements that cause abnormal, sometimes painful
positions.
Or imagine that your hand shakes so badly that you can't write your name
or pour a liquid without spilling it everywhere. Essential tremor is the
rhythmic shaking of a body part, usually a hand or arm, especially when
the person tries to do something like hold a pen or cup. People with
Parkinson's disease also have tremors, as well as muscle stiffness and
slowness of movement.

A new treatment
What do all these neuromuscular disorders have in common? Typically,
people with these conditions are treated with medications, which may or
may not give them relief. But a new therapy, called deep brain
stimulation (DBS), is demonstrating in research studies that it may
provide an excellent way of controlling dystonia and tremors.

A hidden electrical system
Deep brain stimulation involves putting the tip of a hair-thin wire down
inside the brain in a special area that controls movement. The wire then
runs up through a small hole in the skull and under the scalp down to a
little device implanted under the collarbone. The device, called a
neurostimulator, sends tiny electrical impulses down the wire into the
brain. The person can turn the DBS on when needed, and turn it off
during sleep (when tremors are less).

DBS and Parkinson's
The picture for Parkinson's disease is very encouraging. In 1997, the
U.S. Food and Drug Administration (FDA) approved DBS for the treatment
of tremor in Parkinson's disease using a single implanted electrode. In
January 2002 the FDA approved DBS using two implanted electrodes
(bilateral, meaning one on each side of the brain).

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.

DBS and dystonia
About 100 people around the world with dystonia have had a DBS system
implanted. German researchers reported in February 2002 that bilateral
DBS relieved head twitching in five patients with cervical dystonia
(spasmodic torticollis). This is similar to research results in previous
years.

DBS and essential tremor
Given the successes in using DBS to treat the tremors in Parkinson's
disease, researchers have turned to applying DBS to essential tremor. A
U.S. study in 1999 evaluated DBS of 38 people with essential head
tremor. All of the people had less tremors after the DBS system was
implanted. And a Swedish study in January 2002 of 27 people with
essential tremor found all had improved ability to do daily activities.

The future for DBS
Researchers are interested in expanding testing of DBS for other
disorders. Studies have found DBS can relieve chronic nerve-related
pain. In one study, a man given DBS for pain after a stroke also had
some improvement in the arm weakened by the stroke. Possible areas of
study for DBS are in seizure disorders, multiple sclerosis, paralysis,
obsessive-compulsive disorders, and depression. Although the
possibilities are exciting, it will no doubt be many years before DBS
would be used to treat these additional conditions.

Information for this article was taken from:
- Haberler, C., Alesch, F., Mazal, P.R., Pilz, P., Jellinger, K.,
Pinter, M.M., Hainfellner, J.A., & Budka, H. (2000). No tissue damage by
chronic deep brain stimulation in Parkinson's disease. Ann Neurol,
48(3), 372-376.
- Kitagawa, M., Murata, J., Kikuchi, S., Sawamura, Y., Saito, H.,
Sasaki, H., & Tashiro, K. (2000). Deep brain stimulation of subthalamic
area for severe proximal tremor. Neurology, 55(1), 114-116.
- Kumar, R., Dagher, A., Hutchinson, W.D., Lang, A.E., & Lozano, A.M.
(1999). Globus pallidus deep brain stimulation for generalized dystonia:
clinical and PET investigation. Neurology, 53(4), 871-874.
- Mishra, R. "Brain waves of the future, now." The Boston Globe,
February 7, 2002.
- Phillips, N.I., & Bhakta, B.B. (2000). Effect of deep brain
stimulation on limb paresis after stroke. Lancet, 356(9225), 222-223.
- Taira, T., Kawamura, H., & Takakura, K. (1998). Posterior occipital
approach in deep brain stimulation for both pain and involuntary
movement. A case report. Stereotact Funct Neurosurg, 70(1), 52-56.
- Tasker, R.R., & Vilela Filho, O. (1995). Deep brain stimulation for
neuropathic pain. Stereotact Funct Neurosurg, 65(1-4), 122-124.
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