As the world's population grows at an unprecedented rate, we must cope with a significant increase in people suffering with various neurological disorders. This brings with it a range of challenges: from personal well-being to social dynamics, healthcare, and economic systems. Among the issues that arise, there is a substantial increase in mental health disorders, which can significantly impact an individual’s quality of life. One potential avenue for treating various neurological and neuropsychiatric disorders is Deep Brain Stimulation (DBS). This relatively non-invasive technology can boost and coordinate the rhythmic activity of brain circuits, potentially preserving or even enhancing cognitive and mobility performance.
DBS: How does it work?
DBS is a neurosurgical procedure that involves the placement of electrodes within specific brain regions. The electrodes are connected to a device called a pulse generator that sends electrical impulses to the brain. These impulses aim to modulate neural activity and restore more balanced brain function.
Unveiling applications: How DBS can help patients
DBS is used to treat various neurological and psychiatric disorders such as Parkinson’s disease, dystonia, epilepsy, obsessive-compulsive disorder (OCD), and major depression.
Parkinson’s disease: A study conducted by researchers from Carnegie Mellon University discovered that through the use of the well-established ‘bottom- up’ approach, (examining the fundamental components of a complex system and then building an understanding of the larger system based on this information), as opposed to the traditional ‘top-down’ approach, (beginning research with a broader understanding before investigating specific components). This allowed them to define a more precise process of DBS for targeting Parkinson’s, which demonstrates greater symptom relief as well as long lasting effects. This breakthrough ultimately opens the potential for a breakthrough in Parkinson’s treatment.
Depression: DBS has been studied as a potential treatment for severe, treatment-resistant depression. In a study by researchers at the Ichan School of Medicine, DBS was shown to have positive effects on participants that involved a gradual easing of depressive symptoms, as well as generally replacing negative outlooks with positivity. Their research ultimately concluded that DBS holds the potential to greatly impact the lives of people suffering from depression, however more research is needed to fully understand the safety, efficacy, and long-term effects.
OCD: A study undertaken by researchers at the University of California demonstrated the potential modulation of OCD via DBS. They discovered that DBS holds promise as a potential treatment for OCD by modulating neural activity in particular brain regions, via disruption of the dysfunctional circuits responsible for obsessive thoughts and compulsive behaviours. These effects accumulate over time, leading to improvements in OCD symptoms. The ongoing exploration of different implantation sites underscores the complexity of OCD and the potential for DBS to offer relief for individuals who have not responded well to other interventions.
Navigating challenges: What are the potential drawbacks?
While the potential of DBS is great, it comes with its fair share of challenges and considerations:
Precision and targeting: The precise placement of electrodes is crucial for the success of DBS. Striking a delicate balance between accurate positioning and avoiding damage to surrounding brain tissue is a considerable challenge.
Individual variability: Responses to DBS can differ significantly from person to person, necessitating a tailored approach to optimise stimulation settings for each patient.
Long-term effects: Ongoing research is delving into the long-term effects and safety of DBS. Questions about potential side effects and the impact of sustained electrical stimulation are still being explored. Additionally, there is no current evidence that DBS would work as a long-term treatment, as ongoing therapy may be invasive to everyday life.
Ethical and regulatory hurdles: As DBS involves surgical procedures and device implantation, ethical and regulatory considerations surrounding patient consent, long-term monitoring, and potential risks are highlighted by researchers. Other ethical considerations include the resource intensity demanded from DBS procedure. In the current context of limited healthcare resources, the pros and cons of utilising substantial resources, such as the capital costs incurred and the need for a multidisciplinary team, must be considered.
Exploring alternatives: what other directions are there?
Beyond DBS, several alternative treatments and interventions are transforming the field of brain health.
Pharmacotherapy: Medications continue to be a cornerstone of treatment for various neurological and neuropsychiatric disorders, for example the dopamine agonist ‘levodopa’ currently in use to help alleviate the symptoms of Parkinson’s. Ongoing research aims to develop more effective drugs and refine existing treatments.
Cognitive interventions: Non-invasive techniques such as cognitive training and behavioural therapies focus on improving brain function through learning and adaptation, addressing cognitive deficits and mental health challenges. These methods are used to treat memory-related neurological conditions such as Alzheimer’s.
Neuromodulation techniques: Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) are non-invasive approaches that have no surgical intervention. TMS has shown potential in alleviating symptoms of depression, as well as increasing general emotional wellbeing, whereas tDCS demonstrates improvement to cognitive functions such as memory and learning.
In conclusion, DBS is a powerful instrument that can be used for both therapy and research of the pathophysiology of brain disorders. DBS has advanced rapidly over the past two decades, allowing for the process to become a familiar norm within the realm of neurological conditions. The field is still evolving every day, with many aspects of the process still to consider, however, the clear goal is to treat neurological disorders as safely and effectively as possible.
Photo by Milad Fakurian on Unsplash
This article was written by Rebecca Parker and edited by Julia Dabrowska. Interested in writing for WiN UK yourself? Contact us through the blog page and the editors will be in touch!
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