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brain-stimulation:dbs [on October 4, 2017] |
brain-stimulation:dbs [on February 21, 2021] (current) |
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| + | ====== Deep Brain Stimulation (DBS) ====== | ||
| + | {{INLINETOC}} | ||
| + | ===== Primer ===== | ||
| + | <WRAP group> | ||
| + | <WRAP half column> | ||
| + | **Deep Brain Stimulation (DBS)** is a form of [[brain-stimulation:home|brain stimulation]] that involves invasive neurosurgical intervention and implantation of electrodes under MRI guidance into specific brain regions.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994792/|Milev, R. V., Giacobbe, P., Kennedy, S. H., Blumberger, D. M., Daskalakis, Z. J., Downar, J., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. The Canadian Journal of Psychiatry, 61(9), 561-575.]])] It remains an investigational and experimental treatment. | ||
| + | </WRAP> | ||
| + | <WRAP half column> | ||
| + | <catlist brain-stimulation:: -columns:1 -noAddPageButton -sortAscending -noNSInBold> | ||
| + | </WRAP> | ||
| + | </WRAP> | ||
| + | |||
| + | ===== Mechanism of Action ===== | ||
| + | * DBS acts via different mechanisms including causing local neuronal and whole-brain electrophysiological changes secondary to stimulation, changes in synaptic plasticity, modulation of oscillatory waves in the brain, and possibly a role in causing neurogenesis via release of growth factors.[([[https://pubmed.ncbi.nlm.nih.gov/25533682/|Pienaar, I. S., Lee, C. H., Elson, J. L., McGuinness, L., Gentleman, S. M., Kalaria, R. N., & Dexter, D. T. (2015). Deep-brain stimulation associates with improved microvascular integrity in the subthalamic nucleus in Parkinson's disease. Neurobiology of Disease, 74, 392-405.]])] | ||
| + | * The implanted electrodes are peripherally connected to an implantable pulse generator (IPG) that is usually implanted in chest below the right clavicle. | ||
| + | * Settings can be adjusted on this IPG. | ||
| + | |||
| + | ==== Anatomical Target ==== | ||
| + | * In treatment-resistant depression, the neuroanatomical targets are the subcallosal cingulate (SCC) white matter, ventral capsule/ventral striatum (VC/VS), nucleus accumbens, and medial forebrain bundle (MFB). | ||
| + | * The majority of DBS research studies have focused on the subcallosal cingulate.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994792/|Milev, R. V., Giacobbe, P., Kennedy, S. H., Blumberger, D. M., Daskalakis, Z. J., Downar, J., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. The Canadian Journal of Psychiatry, 61(9), 561-575.]])] | ||
| + | |||
| + | ===== Indications ===== | ||
| + | * Movement disorders ([[geri:parkinsons|Parkinson’s disease]]) | ||
| + | * Treatment-resistant depression | ||
| + | |||
| + | ===== Delivery Parameters ===== | ||
| + | * Similar to cardiac pacemakers and VNS, the IPG in DBS can be accessed using a handheld device, allowing the stimulation parameters to be monitored and/or programmed remotely. Modifiable DBS parameters include pulse width, frequency, and amplitude (voltage or current), which can be programmed by the treating physician and titrated to clinical effect. | ||
| + | * The optimal stimulation parameters for different brain regions remains unknown. | ||
| + | |||
| + | ===== Effectiveness ===== | ||
| + | * For treatment-resistant depression, response rates of 30% to 60%, and remission rates of 20% to 40% at 3 to 6 months have been reported.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994792/|Milev, R. V., Giacobbe, P., Kennedy, S. H., Blumberger, D. M., Daskalakis, Z. J., Downar, J., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. The Canadian Journal of Psychiatry, 61(9), 561-575.]])] | ||
| + | |||
| + | ===== Adverse Events ===== | ||
| + | * Adverse events related to the neurosurgical procedure involve intracranial haemorrhage, and perioperative risks such as from general anesthesia and wound infections. | ||
| + | * Non-surgical adverse events include psychosis and hypomania caused by a change in the stimulation parameters in patients receiving DBS in the nucleus accumbens. | ||
| + | * Oculomotor adverse events such as blurred vision and strabismus, have been reported with medial forebrain bundle DBS. | ||
| + | * Cases of suicidality and completed suicide have been reported in DBS studies, but there has been no evidence to show that these were DBS or device related events. | ||
| + | ===== Comparison with Other Brain Stimulation Therapies ===== | ||
| + | ==== Depression ==== | ||
| + | {{page>brain-stimulation:tdcs#depression&nouser&noheader&nodate&nofooter}} | ||