In 2014, Prof. Benabid from Joseph Fourier University in France and Professor DeLong from Emory University School of Medicine in the United States were awarded the “Nobel Prize Vane†for their contribution to the treatment of Parkinson's disease in deep brain stimulation. Lasker Clinical Medicine Award.
Deep brain stimulation is a surgical technique that involves implanting an electrode (in fact, a wire) into the subcortical structure of the brain (that is, deep in the brain) and then attaching the electrode to the stimulator (ie, the battery). Typically the stimulator will be implanted into the subcutaneous tissue beneath the collarbone. Simply put, it is a surgery to safely insert the wires into a specific location in the brain. Since the stimulator (battery) is depleted, a small surgery is needed to replace the battery after a few years.
Deep brain electrical stimulation requires stereotactic techniques to accurately locate specific "target regions" in the brain. Stereotactic is a technique for navigating and performing surgery in three dimensions, usually with the aid of imaging techniques such as X-ray, CT and magnetic resonance. After the doctor drilled a small hole in the skull, the special surgical equipment was used to accurately place the electrode in the predetermined brain target area according to the imaging guidance.
Electrophysiological recordings and electrical stimulation tests are also performed during surgery to ensure that the electrodes are on the neurons that control the symptoms. Each neurological disease has its own specific "target" neural structure. For example, for Parkinson's disease, the target is the subthalamic nucleus or the globus pallidus; for essential tremor, the target is the dorsal nucleus of the thalamus; for epilepsy, the target is the anterior thalamic nucleus.
Because the most effective electrical stimulation intensity and frequency are different for different patients with different diseases, it is necessary to perform program control after surgery to select the most appropriate stimulation parameters. Although the mechanism of deep brain electrical stimulation is unclear, the simplest explanation is that DBS reconnects the brain loop, thereby re-establishing a balance between the inhibitory and excitatory circuits of the brain.
Deep brain electrical stimulation is generally used for severe neuropsychiatric disorders that are insensitive to drug therapy. The current indications for affirmative treatment are Parkinson's disease, idiopathic tremor, dystonia, refractory obsessive-compulsive disorder, especially the clinical effects of Parkinson's disease and idiopathic tremor have been confirmed by a large number of data. In addition, DBS is also used in the treatment of the following diseases: epilepsy, depression, tic disorder, eating disorders, cluster headache, chronic phantom limb pain, addiction, Alzheimer's disease, and vegetative awakening. For patients with advanced Parkinson's disease, the efficacy of DBS combination therapy is superior to optimal drug therapy. For patients with Parkinson's disease who have drug complications ("switch" and dyskinesia), deep brain stimulation is also the best treatment option. Deep brain electrical stimulation is an invasive surgical treatment, so there must be surgical complications such as bleeding, cerebral infarction, infection and scars. Other complications include headaches, neuropsychiatric disorders (emotional changes, apathy and hallucinations, etc.), electrode exposure, battery failure, and inaccurate placement of electrodes. But in general, the risk of this operation is not large, and the incidence of serious surgical complications is very low.
Deep brain stimulation is also known as a pacemaker. This is because the DBS stimulator is similar to an artificial cardiac pacemaker and is a device that emits regular electrical pulse signals. However, unlike the heart's electrical conduction system, there is no cardiac pacing initiation point like the "sinus node" in the brain. The function of the brain is also far more complicated than the heart, and various functions correspond to different neural networks. Therefore, for different diseases, DBS stimulates different brain positions to regulate the neural network. Although there may not be a pacemaker in the brain, the treatment of DBS is as magical as a pacemaker. In the moment when DBS starts to stimulate, people with Parkinson's disease who are unable to move freely for many years can move freely. Patients with long-term depression will describe the immediate environment. And so on, it is not uncommon for doctors who are engaged in DBS treatment.
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