A new definition to being High-wired:
Maybe we can get a DIY forum for human electrical wiring. :laughing:
Its amazing what they can do with today's technology.:thumbsup:
Cleveland doctors are on the leading edge of treating disorders with deep brain stimulation
Posted by Brie Zeltner March 24, 2008 13:30PM
Categories: Impact, Lifestyles Impact
Graphic: A closer look at deep-brain stimulation. (pdf)
Cleveland Clinic neurosurgeon Ali Rezai leans in toward the bluish glow of a laptop, explaining his research. The excitement and conviction is clearly evident in his voice and gestures. "Really this is the beginning of a new era, similar to where heart pacemakers were 30 or 40 years ago," he said, picking up a silver, stopwatch-size device from the table.
Technologically, the comparison is apt.
The device is an impulse generator. When surgically implanted underneath the collarbone, it delivers a low dose of electricity to wires that snake up under the skin and through the top of the skull into the brain itself: a brain pacemaker.
Rezai is one of a small group of neurosurgeons, psychiatrists and neurologists in the country working at the frontier of a technique called deep brain stimulation.
DBS was developed to treat Parkinson's disease and other movement disorders. Now Rezai, director of the Clinic's Center for Neurological Restoration, and Dr. Robert Maciunas, director of the Neurological Institute at University Hospitals Case Medical Center, are on the leading edge of the newest applications of the technology.
It is being studied as a treatment of last resort for disorders such as Tourette'ssyndrome, obesity, anorexia, stroke recovery, traumatic brain injury, epilepsy, cluster headaches, chronic pain and addiction.
Deep brain stimulation useselectric current to change the intricate communication system of the brain, but while the mechanics of the surgery have been almost perfected, researchers still debate exactly what it is they are doing that makes people better.
But people do get better.
In trials involving patients withsevere depression and debilitating obsessive-compulsive disorder, or OCD, who never left their homes or were trapped in lives constrained by repeated rituals, DBS offered help where other treatments had failed.
Diane Hire, 53, managed to work as a physical therapist through the first half of her 20-year depression, but eventually was so debilitated that she almost never left her home in Norwalk.
Like most participants in the experimental trials, Hire was desperate.
None of the drugs or therapies she tried worked, including shock therapy.
"I had given up, thinking that there just wasn't ever going to be any help for me," she said. "For me it was instantaneous. I went from being severely depressed to feeling like I had a whole brand-new life."
From crude techniques to ethical awareness
Deep brain stimulation owes its genesis to a much cruder surgical procedure developed in the 1950s to treat Parkinson's disease. Working first in animals, neurosurgeons found that if they made tiny cuts or burns, called lesions, in the parts of the brain that were overactive in controlling movement, they could stop some of the characteristic muscle spasms and stiffness of the disease.
Surgeons used electrodes in these lesioning surgeries to locate the right spot to burn --stimulation at the right frequency would alter the patient's symptoms and signal that theelectrodes were in the right location.
Lesioning worked much of the time, but the brain tissue, once destroyed with heat or chemical burns, could never be recovered. Mistakes were irreversible.
In 1987 in France, neurosurgeon Alim Benabidtried leaving electrodes in the brain. The first surgery on a Parkinson's patient worked. The stimulation could be turned off or adjusted.
The U.S. Food and Drug Administrationin 1997 approved deep brain stimulation for treatment of Parkinson's and essential tremor, a much more common disorder that causes trembling. It now also is approved to treat dystonia, a rare movement disorder that involves disabling muscle spasms.
The first clinical trials in depression and OCD began in 2002 and 2003 at the Clinic. Trials like these and the later trials treating Tourette's patients at UH get scrutiny because the technology involves an area of neurosurgery with a dark past. Doctors like Rezai and Maciunas daily must deal with the legacy of earlier overzealous practitioners like Walter Freeman, who in the 1940s and '50s literally performed lobotomies with an ice pick.
They are all acutely aware of the ethical issuesinherent in their field.
At the Clinic, for example, clinical trial participants were told that principal investigator Rezai is also the chief scientific officer of Intelect Medical Inc., a Clinic spinoffdeveloping his method for using DBS in stroke and traumatic brain injury victims. The company hopes to begin human trials of the stroke recovery technique this year.
Patients are also told that the trials are partially funded by Minneapolis-based Medtronic, Inc., the only company that makes an FDA-approved device for deep brain stimulation. Medtronic provided all the devices for the trials.
Most patients could not afford the procedure without this support.
Because DBS trials are open only to the most severely ill patients, some worry medically and emotionally fragile patients could be vulnerable and opento exploitation.
But many doctors stress the benefits for those patients.
"Why not do the research on those who can perhaps have the most to benefit?" said Paul Ford, assistant professor of bioethics at the Cleveland Clinic Lerner College of Medicine.
Another fear is that tinkering with emotional centers of the brain may alter a person's personality.
"I think I've become less concerned because what I've seen is these people returning to how they felt before depression. In other words, we don't seem to be turning on some kind of happy circuit that overrides their depression," said Dr. Donald Malone, the psychiatrist who cares for all the patients in the Clinic's trials.
But researchers do seem to be capable of turning on a "happy circuit" and of cranking it up with increased stimulation.
One 37-year-old patient who had a brain pacemaker implanted for Tourette's syndrome found that at certain settings, both she and her boss noticed that she was more creative. Other doctors have reported cases of a persistent elevated mood and hyperactivity.
"I don't think anyone would go through the procedure because they wanted to improve subtly," said Dr. Rees Cosgrove, who performed the surgery on that patient and has since addressed the President's Council on Bioethics on the topic of DBS.
It is brain surgery, he notes, with risks that include hemorrhage, stroke, infection and seizure.
Tourette's trial shows promise
In 2004, Maciunas carried out the first DBS surgery on a patient with Tourette's syndrome in North America. Jeff Matovic of Lyndhurst turned to the surgery because his case of Tourette's, unlike most, had worsened with age.
Matovic came off most of his medications and the tics, erratic movements and grunts that sometimes confined him to his bed are gone. He celebrated his fourth year with the stimulator on March 4, a day his family refers to as his "second birthday."
UH was the first site to get FDA approval to test DBS as a treatment for medically refractoryTourette's syndrome. A study published in November reported that three of five patients had a significant improvement in both tic severity and quality of life measures after three months of treatment. Maciunas plans to expand the trial to more patients this year.
But caution seems to be the order of the day in the advance to new treatment areas.
"These are fragile people who are tremendously ill," Maciunas said. "It's unfair to them to prematurely start doing these surgeries out of empathy without having the data in hand to know for certain that we're doing the right thing."
Even Rezai, who believes the applications for the technology are just beginning to be seen, manages to rein in his enthusiasm a bit.
"We have to do these things very carefully," he said. "Some of these things may sound like science fiction to you, but they have a decade of work behind it."
This is actually "old news," but it's refreshing to see they are still researching brain stimulus. They have made advances in animals, unfortunately they can't get enough feedback and there's a great mortality rate. I'm not sure how much I believe with the cases of the quacks who claim to have "tapped into" the pleasure centers of women. The mysteries of the brain are comparible to the universe. At least we are past shock therapy.
I have a bad case of Tourette's...it comes out in the middle of traffic sometimes. :laughing:
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