Monday, May 20, 2013

Man makes medical history with device to control seizures


This copy is for your personal, noncommercial use only. You can order presentation-ready copies for distribution to your colleagues, clients or customers here or use the "Reprints" tool that appears above any article. Order a reprint of this article now.


Man makes medical history with device to control seizures

By
The Dispatch
Published: Monday, May 20, 2013 at 11:52 a.m.
 

Contributed photo
Toney Kincaid is shown with his wife, Betty. Kincaid has a vagus nerve stimulation implant to control seizures.
Toney Kincaid spends much of his time keeping his grandchildren, whom he once thought he would never see.

He was a ticking time bomb.

Ironically, a watch-like device gave him back his life. And little did he know he would become part of medical history, only the second person in the world to have a vagus nerve stimulation implant and the first person in the world to become seizure free because of it.

The nadir of his existence materialized in 1983 in the cafeteria of the Duracell Battery plant on U.S. Highway 64 where he worked. In front of some 200 coworkers, he began staggering, then convulsing. It wasn't just any seizure he was having. It was a grand mal seizure, the one that is characterized by a loss of consciousness and violent muscle contractions.

From that point, the Lexington native's life spiraled downhill. He lost his job, health insurance, driver's license and self-esteem. He still had his seizures, though — up to 3,000 a month. By 1988, his epilepsy was so out of control that doctors feared he didn't have much time to live.

"When my seizures began in 1983, I did not know how a seizure could take control of my body, and I had no control," remembers Kincaid, who is now 61 and lives in the Holly Grove community. "I would become confused and began to feel my body drawing, then I would lose consciousness. During these years, my family could not understand what was going on with me."

Kincaid's medical problem stemmed from abnormal and poorly formed blood vessels in the brain. Its medical term is arteriovenous malformation.

He had pioneering brain surgery for that in 1970 when he was 20 years old. "That was uncharted grounds back then. They didn't know a lot about it back then," Kincaid explains.

Scar tissue from the surgery resulted in his epidemic of seizures.

In 1984, he connected with fellow Davidson County native Dr. J. Kiffin Penry of Denton, a renowned neurologist and researcher who was in the forefront of efforts to improve medical treatment of epileptics. Penry, a former professor at the Bowman Gray School of Medicine at Wake Forest University, who died in 1996, told Kincaid he had two hard choices. He could become essentially a guinea pig for the fledging clinical research or die.

He choose the former but found no instant results. None of the four types of research drugs quelled his seizures.

"I was at my breaking point after being in research trials for five years, and nothing would control my seizures," says Kincaid, who explains he became virtually homebound. It was difficult to function in public. Many of his friends and acquaintances did not understand his malady and kept their distance. Parents of his children's friends would not allow them to visit.

A crude version of the stimulator was first implanted in animals.

Penry was the first to conduct such clinical tests on humans. "I remember Dr. Penry telling me, 'an old dog can't talk, so we're going to put it in you,'" Kincaid says.

According to Invention and Technology Magazine, the treatment involved implanting a cookie-sized device below the left collarbone, with positive and negative leads threaded up to the vagus nerve, around which were wrapped two platinum-foil coils. The two leads essentially created a closed circuit among battery, wires and nerve, thereby concentrating the current on the nerve better than a single lead and decreasing side effects. Penry used a computer to specify the frequency, strength and duration of the stimulations based on experience and the characteristics of the individual case.

Over nine months, beginning in March 1989, Penry slowly increased the strength of the stimulation he gave Kincaid. July 31,1989, was the first seizure-free day Kincaid could remember, and in January 1990 he had his last seizure.

"It's like a pacemaker for the brain," Kincaid describes.

Cyberonics of Houston, Texas, developed the VNS Therapy System. The treatment option recently hit a milestone of 15 years since FDA approval.

"Without this device I would not be living today," Kincaid says. Over the years he has had a half dozen different implants and two of the three different models of the Cyberonics product. The latest stimulator on the market is about the size of a small pocket watch with an indefinite battery life.

Kincaid plans to upgrade to the newest model in the near future.

"I would not have the ability to be a functional part of society without the device," Kincaid says. "With all my seizures, I had no short-term memory. I was unable to remember my children's names or to read. Everything became entangled. My wife could not leave me unattended."

The life-changing device, Kincaid says, "has given me back my self-respect. I felt useless and not worthy of being a husband or parent. When I was homebound for so long, it seemed there would never be any hope for my seizure disorder."

In addition to Penry, Kincaid says he is also indebted to his wife, Betty. They will celebrate their 40th anniversary this October.

The two often speak at medical conferences about the device.

"When we first started, Cyberonics wanted to hear my wife's side of the story. My seizures devastated our family. Our kids were afraid they would come home and find their daddy dead."

Kincaid says he is in relatively good health, though he has some weakness on his left side, which he attributes to his brain surgery.

He wants those who suffer from epileptic seizures to know about the device and how it can change their lives.

Dwight Davis can be reached at 249-3981, ext, 226 or at dwight.davis@the-dispatch.com.

http://www.the-dispatch.com/article/20130520/LIVING/305209993



Transcranial magnetic stimulation used for depression treatment

Transcranial magnetic stimulation used for depression treatment


Local doctors use magnets to effectively treat depression

Published  9:49 AM EDT May 20, 2013


DANVERS, Mass. -
 
Thomasina Bedingfield has battled major depression for 50 years and dealt with endless failed treatments.
 
"When I was 22, they were giving me tranquilizers,” said Bedingfield.
 
“She was taking a number of medications, but despite that was still very anxious, having trouble functioning, crying all the time,” said Dr. Barry Ginsberg, chief of psychiatry at Beverly Hospital, a member of Lahey Health.
 
But thanks to a new treatment called Transcranial Magnetic Stimulation, or TMS therapy, the 71-year-old can finally say she’s happy.
 
“It involves stimulating a particular area of the brain with a rapidly pulsating, strong magnetic field,” said Ginsberg.
 
That area, the left, prefrontal cortex, is believed to regulate mood, and when someone's depressed, isn't as active as it should be.
 
The FDA-approved treatment kicks it back into high gear with magnetic pulses about the strength of an MRI.
 
“You do see people who've just had a response to TMS that they don't get to anything else,” said Ginsberg.
 
That includes people like Bedingfield, with major depression who've tried antidepressants without success. According to studies, two out of three feel better and one in three patients are completely symptom-free after six weeks of treatment.
 
“It’s just as effective, maybe even more effective, for people who are earlier in their course of depression,” said Ginsberg.
 
In extremely rare cases, TMS therapy can cause seizures, but “that's less than one in every 10,000 treatments,” said Ginsberg.
 
The most common complaint is a tapping feeling during the 37-minute treatment.
 
“It’s slightly unpleasant at the first treatment, and after that, it's nothing at all. People oftentimes go to sleep during the sessions,” said Ginsberg.
 
Treatments initially are five days a week for four to six weeks.
 
“When I got halfway through, I knew I was better,” said Bedingfield.
 
Experts say the sky's the limit for this new technology and are researching other uses from weight loss to treating pain disorders and migraines.
 

Saturday, May 18, 2013

Vagal nerve stimulation in children under 12 years old with medically intractable epilepsy.

Childs Nerv Syst. 2013 May 17. [Epub ahead of print]

Vagal nerve stimulation in children under 12 years old with medically intractable epilepsy.



Source

College of Medicine, University Hospital of Wales, Cardiff, UK.

Abstract

OBJECTIVE:

This study aims to assess the efficacy and safety of vagal nerve stimulation (VNS) in children less than 12 years old operated on at the University Hospital Wales.

METHOD:

Retrospective review of patients undergoing VNS insertion, over a 3-year period, was undertaken. All children had a minimum follow-up period of 2 years. Sixteen patients were identified via the paediatric epilepsy surgery database. A case note review and telephone evaluation was conducted. Seizure frequency using the McHugh classification was the primary outcome measure, with anti-epileptic drug (AED) use as a secondary outcome measure.

RESULTS:

There were 10 males and 6 females. The mean time with epilepsy prior to surgery was 5.7 years and the mean age at the time of surgery was 7.6 years. Overall, nine (56 %) children experienced a reduction in their seizure frequency of 50 % or more. Of these, four (25 %) had a reduction of more than 80 %. Seven children (44 %) had no reduction in their seizure frequency, although two of these patients reported benefit regarding seizure control and post-ictal recovery. The VNS system was removed in two patients due to infection and no benefit, respectively. Half of the cohort (50 %) reduced the number of anti-epileptic drugs post-surgery, and there was an overall mean reduction of AED of 0.5.

CONCLUSION:

This study suggests that VNS is a safe and effective adjuvant therapy in children under 12 years old, with over half reporting significant benefit. Further studies are needed to enable preoperative selection of patients in order to maximise the potential benefit.

PMID:
23681311
[PubMed - as supplied by publisher]
 
http://www.ncbi.nlm.nih.gov/pubmed/23681311

Thursday, May 16, 2013

Vagus Nerve Stimulation Effective in Resistant Depression

Medscape Medical News > Psychiatry

Vagus Nerve Stimulation Effective in Resistant Depression

Fran Lowry
May 16, 2013

Vagus nerve stimulation (VNS) appears to be effective for treatment-resistant depression and may induce changes in brain metabolism weeks or even months before patients begin to feel better, new imaging research suggests.
 
"These neuroimaging findings suggest that antidepressant response to VNS has very large and profound effects early on in the cortex of the brain, altering the metabolic activity in cortical regions, in individuals with treatment-resistant depression," lead author Charles R. Conway, MD, of the Washington University School of Medicine, St. Louis, Missouri, told Medscape Medical News.

"The regions affected are regions known to be associated with depression, the dorsolateral prefrontal cortex, the orbitofrontal cortex, and the anterior insular cortex.

"These changes in metabolic activity occur prior to any noticeable clinical effects or improvements. The patient does not appear to be getting less depressed, which suggests that the early part of VNS, the first 1 to 5 months, may actually be bringing about changes, or setting the stage, for later clinical effects which will follow 6 months or more," said Dr. Conway

He added that at 12 months, he and his team of investigators also were seeing increases in regional metabolic activity in brainstem regions associated with depression, most especially a region of the brain associated with dopaminergic brain function, the ventral tegmental area.

The study is published online ahead of print in Brain Stimulation.

Profound and Sustained Improvement
                   
Dr. Conway and his team have implanted VNS devices in some 70 treatment-resistant depression patients.

"Although not everyone responds to VNS, we have seen numerous patients experience very profound and sustained improvements in treatment-resistant depression, and many have been doing well for years," he said.

Dr. Charles Conway
 
"Many of these patients have gone from being essentially incapacitated by depression to fully functional again."

The researchers hypothesized that any treatment that brings about such a profound improvement must have observable brain changes associated with it, and this prompted their neuroimaging study.

In the current study, Dr. Conway and his group followed 13 patients with treatment-resistant depression whose symptoms had not improved despite many months of treatment with as many as 5 different antidepressant medications.

Most of the patients had been depressed for at least 2 years, but some patients had been clinically depressed for more than 20 years.

All patients underwent surgery to have the VNS device inserted. The left vagus nerve runs down the side of the body from the brainstem to the abdomen; once activated, the VNS device delivers a 30-second electronic stimulus to the vagus nerve every 5 minutes.

To establish the nature of the treatment's effects on brain activity, the investigators performed positron emission tomography (PET) brain imaging prior to the initiation of stimulation, and again 3 and 12 months after stimulation had begun.

They then compared these brain scans with each other at different time points.

"We used a form of PET which uses radioactively labeled glucose, fluorodeoxyglucose, or FDG," Dr. Conway explained. "The brain is constantly taking up glucose from the blood stream. If there is a regional decrease in metabolism, typically associated with decreased regional brain activity, this can be detected using FDG-PET, because you see less FDG uptake in a given region."

FDA Approved, But Not Widely Available
                   
Eventually, 9 of the 13 patients experienced improvement in depression with the VNS treatment. However, in most cases, it took several months for improvement to occur.

Among those who responded, the FDG-PET scans showed significant changes in brain metabolism following 3 months of stimulation, and this occurred several months before any improvements in their symptoms of depression were noted.

"We saw very large changes in brain metabolism occurring far in advance of any improvement in mood. It's almost as if there's an adaptive process that occurs. First the brain begins to function differently. Then the patient's mood begins to improve," Dr. Conway said.

Although this study is preliminary and a larger version of this study should be done, these findings suggest that antidepressant responders to VNS undergo changes in brain activity associated with regional metabolic activity changes in regions associated with depression, Dr. Conway said.

"The data also suggest that the eventual VNS-responding state involves activation of brainstem regions associated with dopamine activity," he said.

Despite being FDA-approved for treatment-resistant depression, VNS is not easily available for the general public because insurance carriers will not reimburse for the treatment, Dr. Conway said.
"We believe that this study, like many other recent studies as well as our extensive clinical experience, support our clinical observations that this treatment is effective. Also, this population of treatment-resistant depression patients has very few viable successful treatments, and we believe VNS is both effective and has sustained benefit in a significant subset of patients with TRD, and it should be available to those who need it."

Need for Replication
                   
Commenting on the study for Medscape Medical News, William Bunney, MD, Distinguished Professor and Della Martin Chair of Psychiatry, University of California, Irvine, said that the high response rate in this patient population is "therapeutically interesting and may be due in part to the selection criteria used in this research."

Dr. William Bunney

Dr. Bunney added that the observation that the patients did not relapse during a 12-month period "has important treatment implications in a disorder characterized by recurrent depressive episodes.

Although this is a somewhat invasive therapy, it may be justified by the high success rate, particularly if it is replicated in other studies using similar research designs."
 
Dr. Conway reports financial relationships with Cyberonics, Merck, and Bristol-Myers Squibb. Dr. Bunney reports that he is a member of the Pritzker Neuropsychiatric Disorders Research Consortium, which is supported by Pritzker Neuropsychiatric Disorders Research Fund LLC. The study was supported by funding from the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Alliance for Research in Schizophrenia and Affective Disorders, and the Sidney R. Baer Jr Foundation. Cyberonics (Houston, Texas) donated 3 cost-free devices to participants in this trial.
                    
Brain Stimul. Published online ahead of print February 15, 2013. Abstract

http://www.medscape.com/viewarticle/804311

Electrical Stimulation Might Improve The Brain's Capacity For Math  


Alice G. Walton










Alice G. Walton, Contributor
I cover health, medicine, psychology and neuroscience.
 
5/16/2013 @ 1:47PM |5,189 views        

English: Phillippine stock market board
(Photo credit: Wikipedia)
 
For people who aren’t so good at math, a mild form of brain stimulation may improve your proficiency. The relatively new form of electrical stimulation is apparently gentler than previously tested methods, so you don’t feel as much like your head is being zapped. And a new study, carried out by a team at the University of Oxford, has implications not only for math, but possibly for “stimulating” other types of cognitive skills. Since math ability relies on fairly high-level cognition, the authors suggest that applying it to lower-level ones will be, well, a no-brainer in the end.

In previous research, Oxford’s Roi Cohen Kadosh and colleagues had found that a form of brain stimulation called transcranial direct current stimulation (TDCS), which places electrodes on the skull, helped people learn and remember a novel set of numbers. This form was effective at improving certain math skills, but not always pleasant for the subject, and came with some adverse effects.


But the new study uses a different form of stimulation, known as transcranial random noise stimulation (TRNS), which applies randomly fluctuating currents (within certain parameters) to the head. According to Cohen Kadosh, the nice part is you don’t feel any of its brain stimulating action. In the study, he and colleagues focused on an area of the brain called the left dorsolateral prefrontal cortex (DLPFC), which has been strongly implicated in our ability to play with numbers in our heads.
 

As they were undergoing the stimulation, 25 Oxford students complete numbers tasks involving bizarre calculations: for example, 4 # 12 = 17. They did these for five days, and improved over time. The control group received sham stimulation while learning the new math. At the end of the training period, the participants who’d received TRNS were significantly faster at doing the calculations than the control group – and these changes seemed to persist over time.

“With just five days of cognitive training and noninvasive, painless brain stimulation, we were able to bring about long-lasting improvements in cognitive and brain functions,” says Cohen Kadosh. When students were called back to the lab six months later, they TRNS group was still 28% faster at solving the problems.

So what exactly is the TRNS doing to the brain to account for these improvements? The authors were interested in illustrating just this, so they tracked various measures of brain metabolism in the TRNS group and the controls. What they found was fascinating: blood flow in the area was actually reduced in the TRNS group, but oxygen consumption was not. This suggests that brain cells were working more efficiently, firing more with more synchronization, which could be the main effect of TRNS. If electric “noise” is reduced, the authors explain, it would mean that less blood flow is required for the same amount of brain activity.

The results of this study might be far reaching. In addition to the 5-7% of the population who suffers from dyscalculia (the numbers form of dyslexia), about 20% of school-age children have significant problems in math. This technique might help them gain better skills. It might also be applied, in different ways, to the great number of people who have various cognitive problems due to neurodevelopmental disorders or neurodegenerative diseases.

“Maths is a highly complex cognitive faculty that is based on a myriad of different abilities,” Cohen Kadosh says. “If we can enhance mathematics, therefore, there is a good chance that we will be able to enhance simpler cognitive functions.”

While TRNS hasn’t been associated with any adverse effects, TDCS, mentioned earlier, has recently been linked to certain adverse neurological effects, by Cohen Kadosh and his team themselves.

Future research will have to assess whether any costs come along with TRNS, as well as how long the beneficial effects really last.

It’s exciting, if a little troublesome, to think about the applications that might exist with this type of stimulation. If you’re preparing for a test or about to do your tax refund, will you be able to go to your local stimulation center for a little pre-event zap? Will mild brain stimulation be the new Adderall? Hopefully it will be reserved for people with documented math disabilities or brain disorders, but time will tell what the applications may be.

Wednesday, May 15, 2013

'Good Vibrations:' Brain Ultrasound Improves Mood


'Good Vibrations:' Brain Ultrasound Improves Mood



May 15, 2013 — Non-invasive brain stimulation techniques aimed at mental and neurological conditions include transcranial magnetic stimulation (TMS) for depression, and transcranial direct current (electrical) stimulation (tDCS), shown to improve memory. Transcranial ultrasound stimulation (TUS) has also shown promise.
Ultrasound consists of mechanical vibrations, like sound, but with frequencies far greater than the upper limit of human hearing, around 20 thousand to 20 million cycles per second (20 kilohertz to 20 megahertz). Ultrasound vibrations penetrate bodily tissue including bone, and are widely used to image anatomical structures via echo effects, e.g. visualizing unborn babies in mothers' wombs, and organs, blood vessels, nerves and other structures in medical procedures. Virtually every part of the body, including the brain, has been safely imaged with low to moderate intensity ultrasound.

High intensity, focused ultrasound can damage tissue by heating and cavitation, and has been used to ablate tumors and other lesions. 'Sub-thermal' ultrasound can safely stimulate neural tissue. In 2002 a UCLA group led by Alexander Bystritsky noticed beneficial side effects in psychiatric patients whose brains were imaged by TUS. A team led by Virginia Tech's W. Jamie Tyler has shown TUS-induced behavioral and electrophysiological changes in animals. A Harvard group led by S-S Yoo has used focused ultrasound aimed at mouse motor cortex to wag the mouse's tail. But clinical trials of TUS aimed at human mental states have been lacking.

Now, in an article in the journal Brain Stimulation, a group from the Departments of Anesthesiology and Radiology at the University of Arizona Medical Center in Tucson, Arizona has investigated TUS for modulating mental states in a pilot study in human volunteers suffering from chronic pain. A clinical ultrasound imaging device (General Electric LOGIQe) was used, with the ultrasound probe applied at the scalp overlying the brain's temporal and frontal cortex (visible on the imaging screen). In random order, each subject received two 15 second exposures: sham/placebo, and 8 megahertz ultrasound (undetectable to subjects). Following exposure, subjects reported (by visual analog scales) significant improvement in mood both 10 minutes and 40 minutes after TUS, but not after sham/placebo. In a followup study (led by University of Arizona psychologists Jay Sanguineti and John JB Allen) preliminary results suggest 2 megahertz TUS (which traverses skull more readily) may be more effective in mood enhancement than 8 megahertz TUS.

The mechanism by which TUS can affect mental states is unknown (as is the mechanism by which the brain produces mental states). Tyler proposed TUS acts by vibrational stretching of neuronal membranes and/or extracellular matrix, but two recent papers from the group of Anirban Bandyopadhyay at National Institute of Material Sciences (NIMS) in Tsukuba, Japan (Sahu et al. [2013] Appl. Phys. Letts. 102, 123701; Sahu et al [2013] Biosensors and Bioelectronics 47:141) have suggested another possibility. The NIMS group used nanotechnology to study conductive properties of individual microtubules, protein polymers of tubulin (the brain's most prevalent protein). Major components of the neuronal cytoskeleton, microtubules grow and extend neurons, form and regulate synapses, are disrupted in Alzheimer's disease, and theoretically linked to information processing, memory encoding and mental states. Bandyopadhyay's NIMS group found that microtubules have remarkable electronic conductive properties when excited at certain specific resonant frequencies, e.g. in the low megahertz, precisely the range of TUS.

Dr. Stuart Hameroff, lead author on the new TUS study, said: "This suggests TUS may stimulate natural megahertz resonances in brain microtubules, enhancing not only mood and conscious mental states, but perhaps also microtubule functions in synaptic plasticity, nerve growth and repair. We plan further studies of TUS on traumatic brain injury, Alzheimer's disease and post-traumatic stress disorders. 'Tuning the tubules' may help a variety of mental states and cognitive disorders."

http://www.sciencedaily.com/releases/2013/05/130515094825.htm

Tuesday, May 14, 2013

1.Deep brain stimulation: a fix when the drugs don’t work



  1. 5mz7jv4q-1368163791
    Implanted electrodes can alleviate symptoms of Parkinson’s and Alzheimer’s, and help treat addiction. Wikimedia Commons

    Neurological disorders can have a devastating impact on the lives of sufferers and their families.



  2. Drug treatments are often ineffective in these disorders. But what if there was a way to simply switch off a devastating tremor, or boost a fading memory?


  3. Recent advances using Deep Brain Stimulation (DBS) in selective brain regions have provided therapeutic benefits and have allowed those affected by these neurological disorders freedom from their symptoms, in absence of an existing cure.

    A pacemaker for the brain

    Artificial cardiac pacemakers are typically associated with controlling and resynchronising heartbeats by electrical stimulation of the heart muscle.
    Schematic of deep brain stimulation. stutteringmedia
    Click to enlarge

    In a similar manner, DBS sends electrical impulses to specific parts of the brain that control discrete functions. This stimulation evokes control over the neural activity within these regions.
    Prior to switching on the electrical stimulation, electrodes are surgically implanted within precise brain regions to control a specific function.


  4. The neurosurgery is conducted under local anaesthetic to maintain consciousness in the patient. This ensures that the electrode does not damage critical brain regions.



  5. Following recovery from surgery the electrodes are activated and the current calibrated by a neurologist to determine the optimal stimulation parameters.


  6. The patient can then control whether the electrodes are on or off by a remote battery-powered device.


  7. Deep Brain Stimulation surgery.

    Turning off tremors

    Perhaps the most documented success of DBS is in the control of tremors and motor coordination in Parkinson’s disease.


  8. This is caused by the degeneration of neurons in an area of the brain called the substantia nigra. These neurons secrete the neurotransmitter dopamine.
    Basal ganglia circuits, including substantia nigra. Wikimedia Commons
    Click to enlarge

    Deterioration of these neurons reduces the amount of dopamine available to be released in a brain area involved in movement, the basal ganglia.


  9. Drug therapy for Parkinson’s disease involves the use of levodopa (L-DOPA), a form of dopamine that can cross the blood brain barrier and then be synthesised into dopamine.


  10. The administration of L-DOPA temporarily reduces the motor symptoms by increasing dopamine concentrations in the brain. However, side effects of this treatment include nausea and disordered movement.


  11. DBS has been shown to provide relief from the motoric symptoms of Parkinson’s disease and essential tremors.



  12. These are regions innervated by the deteriorating substantia nigra, therefore the DBS boosts stimulation to these areas.


  13. Patients can then switch on the electrodes, stimulating these brain regions to enhance control of movement and diminish tremors.

    Restoring fading memories

    Recently, DBS has been used to diminish memory deficits associated with Alzheimer’s disease, a progressive and terminal form of dementia.
    British author Terry Pratchett has been diagnosed with Alzheimer’s Disease. Bolt of Blue

    The pathologies associated with Alzheimer’s disease involve the formation of amyloid plaques and neurofibrillary tangles within the brain leading to dysfunction and death of neurons.


  14. Brain regions primarily affected include the temporal lobes, containing important memory structures including the hippocampus.


  15. Recent clinical trials with DBS involve the implantation of electrodes within the fornix – a structure connecting the left and right hippocampi together.


  16. By stimulating neural activity within the hippocampi via the fornix, memory deficits associated with Alzheimer’s disease can be improved, enhancing the daily functioning of patients and slowing the progression of cognitive decline.

    Deactivating addiction

    Another use of DBS is in the treatment of substance abuse and drug addiction. Substance-related addictions constitute the most frequently occurring psychiatric disease category and patients are prone to relapse following rehabilitative treatment.



  17. Understanding of the reward systems affected in addiction has created a range of treatment options that directly target dysregulated brain circuits in order to normalise functionality.


  18. One of the key reward regions in the brain is the nucleus accumbens and this has been used as a DBS target to control addiction.


  19. Translational animal research has indicated that stimulation of the nucleus accumbens decreases drug seeking in models of addiction. Clinical studies have shown improved abstinence in both heroin addicts and alcoholics.
    Diagram of a rat self-administering morphine. Wikimedia Commons
    Click to enlarge

    Studies have extended the use of DBS to potentially restore control of maladaptive eating behaviours such as compulsive binge eating.


  20. In a recent study, binge eating of a high fat food in mice was decreased by DBS of the nucleus accumbens. This is the first study demonstrating that DBS can control maladaptive eating behaviours and may be a potential therapeutic tool in obesity.


  21. Despite its therapeutic use for more than a decade, the neural mechanism of DBS is still not yet fully understood.


  22. The remedial effect is proposed to involve modulation of the dopamine system – and this seems particularly relevant in the context of Parkinson’s disease and addiction.


  23. DBS potentially has effects on the functional activity of other interconnected brain systems. While it can provide therapeutic relief from symptoms of neurological diseases, it does not treat the underlying pathology.


  24. But it provides both effective and rapid intervention from the effects of debilitating illnesses, restoring activity in deteriorating brain regions and aids understanding of the brain circuits involved in these disorders.