Expanding Applications of Deep Brain Stimulation

Abstract

Deep brain stimulation (DBS) has proved to be a highly effective therapy for multiple types of movement disorders. Because of its well‐tolerated procedure, low side effect profile and high degree of titratability, it has been increasingly explored as an adjunctive therapy for patients refractory to conventional care. This article examines the potential efficacy of DBS for neurological and psychiatric disorders currently under investigation. Pilot studies and clinical trials have been instructive in guiding clinicians and researchers as they seek to elucidate whether DBS is efficacious for indications like epilepsy, Tourette syndrome, addiction and even obesity. Continuing refinement of patient selection protocols and stimulatory parameters, as well as advances in stimulatory tools and surgical procedures, has contributed to these expanding applications of DBS.

Key Concepts:

  • Titratability is one of the key strengths of DBS as it allows clinicians the ability to adjust the ‘dose’ of stimulation at any point after implantation.

  • The refractory nature of neuropsychiatric disorders has created the need for direct, brain‐targeted treatments like DBS that can address treatment‐resistant cases.

  • Parkinson disease, a disorder resulting from the degeneration of dopamine‐producing cells in the substantia nigra, has been well treated by DBS for more than a decade.

  • Clinical trials, such as the SANTE trials, are crucial for demonstrating the efficacy of an experimental treatment like DBS.

  • Closed‐loop systems incorporate cortical EEG monitoring to time stimulatory pulses with pathological neural activity, prospectively increasing the efficacy of DBS for conditions like epilepsy.

  • The ‘psychiatric armamentarium’ describes the treatments and tools, mostly pharmaceuticals, available with clinicians in order to treat patients diagnosed with neuropsychiatric disorders.

Keywords: Deep brain stimulation; Parkinson disease; essential tremor; dystonia; epilepsy; Tourette syndrome; addiction; obesity; depression; refractory; modulation

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Further Reading

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Tekriwal, Anand, Keshavan, Arjuna, Halpern, Casey H, and Baltuch, Gordon H(Feb 2014) Expanding Applications of Deep Brain Stimulation. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0020283.pub2]