Indications For Deep Brain Stimulation Research Articles

Pursuing New Targets and Indications for Deep Brain Stimulation: Considerations for Device-Related Clinical Research in the United States

DBS surgical research is particularly challenging since the FDA has classified DBS as a class III or “significant risk device.” To study novel targets or indications for a “significant risk device,” an investigator must obtain both FDA and institutional review board (IRB) approval. We believe that investigators should be better informed about the barriers surrounding medical device research and we would like to provide a roadmap for conducting investigational DBS surgery in humans.

A novel approach to investigate neuronal network activity patterns affected by deep brain stimulation in rats

The establishment of new therapeutic indications for deep brain stimulation (DBS) is ambitiously promoted though the underlying mechanisms remain contested. Here, we report that PET-imaging and subsequent c-Fos-immunostaining in rats constitute a new translational approach to further understand DBS-mechanisms and -effectiveness.

Estimulación cerebral profunda talámica para la epilepsia resistente

Epilepsy is a neurological disorder that affects 1-2% of the population. Despite the available treatments (drug therapy, resective surgery, vagus nerve stimulation), there is a significant subgroup of patients that continues to have disabling seizures. The indications of deep brain stimulation are exponentially growing, and there is a wide experience with deep brain stimulation (DBS) for the treatment of abnormal movements. DBS for epilepsy may be a new therapy for the subgroup of patients that remain disabled despite other treatments. Experiments with animal models, and the new advances in our knowledge about the neurophysiological processes that govern the genesis of epilepsy, have led to the selection of various brain targets for stimulation. The thalamus is a fundamental relay centre in the corticothalamic and corticostriatal thalamocortical circuits, and it has been studied with this purpose. Studies on epileptic patients have shown various degrees of effectiveness; however, controlled studies do not permit definitive conclusions about the role of DBS in the treatment of epilepsy. Probably a better patient selection would lead to more decisive conclusions. Further randomised studies are needed to draw reliable conclusions and scientific evidence on the effectiveness of DBS for refractory epilepsy.

Current and future indications for deep brain stimulation in pediatric populations

Deep brain stimulation (DBS) has proven to be an effective and safe treatment option in patients with various advanced and treatment-refractory conditions. Thus far, most of the experience with DBS has been in the movement disorder literature, and more specifically in the adult population, where its use in conditions such as Parkinson disease has revolutionized management strategies. The pediatric population, however, can also be afflicted by functionally incapacitating neurological conditions that remain refractory despite the clinicians' best efforts. In such cases, DBS offers an additional treatment alternative. In this paper, the authors review their institution's experience with DBS in the pediatric population, and provide an overview of the literature on DBS in children. The authors conclude that DBS in children can and should be considered a valid and effective treatment option, albeit in highly specific and carefully selected cases.

脳深部刺激療法(DBS)はどんな症例に有効か(<特集>一般脳神経外科医が知っておくべきsubspecialtyの知識)

脳深部刺激療法(DBS)はどんな症例に有効か(<特集>一般脳神経外科医が知っておくべきsubspecialtyの知識)

Deep brain stimulation: indications and evidence

Deep brain stimulation is a minimally invasive targeted neurosurgical intervention that enables structures deep in the brain to be stimulated electrically by an implanted pacemaker. It has become the treatment of choice for Parkinson’s disease, refractory to, or complicated by, drug therapy. Its efficacy has been demonstrated robustly by randomized, controlled clinical trials, with multiple novel brain targets having been discovered in the last 20 years. Multifarious clinical indications for deep brain stimulation now exist, including dystonia and tremor in movement disorders; depression, obsessive–compulsive disorder and Tourette’s syndrome in psychiatry; epilepsy, cluster headache and chronic pain, including pain from stroke, amputation, trigeminal neuralgia and multiple sclerosis. Current research augurs for novel indications, including hypertension and orthostatic hypotension. The development, principles, indications and effectiveness of the technique are reviewed here. While deep brain stimulation is a standard and widely accepted treatment for Parkinson’s disease after 20 years of experience, in chronic pain it remains restricted to a handful of experienced, specialist centers willing to publish outcomes despite its use for over 50 years. Reasons are reviewed and novel approaches to appraising clinical evidence in functional neurosurgery are suggested.

Tiefe Hirnstimulation bei psychischen Erkrankungen - Indikation in Einzelfällen bei Depressionen, Zwangsstörungen, Tourette-Syndrom und tardiven Dyskinesien

Der Einsatz der tiefen Hirnstimulation bei neurologischen Krankheitsbildern wie M. Parkinson und Dystonie haben die Frage aufgeworfen, welche psychischen Krankheitsbilder als Indikation in Frage kommen. Bis jetzt liegen zu den Krankheitsbildern Depression, Zwangsstörung, Tourette-Syndrom und tardive Dystonien positive Einzelfallberichte oder kleine Fallserien vor. Die Indikation wurde jeweils nach der Ausschöpfung medikamentöser und psychotherapeutischer Therapieoptionen gestellt. Zielgebiete sind bei der Depression ein subgenuales zinguläres Areal oder der Nucleus accumbens. Bei der Zwangsstörung werden Areale im Bereich des vorderen Schenkels der Capsula interna oder des Nucleus accumbens als Zielpunkte stimuliert. Für das Tourette-Syndrom liegen Ergebnisse für die Stimulation in Subarealen des Thalamus, im Globus pallidus internus und im Nucleus accumbens vor. Zur Behandlung der tardiven Dystonien wurde im Globus pallidus internus stimuliert.