Editing Deep brain stimulation (section)

{{Short description|Neurosurgical treatment}}
{{Merge from|Adaptive deep brain stimulation|discuss=Talk:Deep brain stimulation#Proposed merge of Adaptive deep brain stimulation into Deep brain stimulation|date=January 2025}}
{{Infobox medical intervention
| name         = Deep brain stimulation
| synonym      =
| image        = Tiefe Hirnstimulation - Sonden RoeSchaedel ap.jpg
| caption      = DBS-probes shown in X-ray of the skull (white areas around [[maxilla]] and [[mandible]] represent metal [[dentures]] and are unrelated to DBS devices)
| alt          =
| pronounce    =
| specialty    = [[Neurosurgery]]
| ICD10        =nij
| ICD9         =
| ICD9unlinked =
| CPT          =
| MeshID       = D046690
| LOINC        =
| other_codes  =
| MedlinePlus  = 007453
| eMedicine    =
| Outcome      =
}}

'''Deep brain stimulation''' ('''DBS''') is a type of [[neurostimulation]] therapy in which an [[implantable pulse generator]] is [[stereotactic surgery|surgically]] implanted [[subcutaneous tissue|below the skin]] of the chest and connected by [[Lead (electronics)|leads]] to the brain to deliver controlled [[electrical charge|electrical impulses]]. These charges therapeutically disrupt and promote dysfunctional nervous system circuits bidirectionally in both ante- and [[retrograde signaling|retrograde]] directions.<ref name="Lancet Neurol 2014">{{cite journal |last1=Castrioto |first1=A |last2=Lhommée |first2=E |last3=Moro |first3=E |last4=Krack |first4=P |title=Mood and behavioural effects of subthalamic stimulation in Parkinson's disease. |journal=The Lancet. Neurology |date=March 2014 |volume=13 |issue=3 |pages=287–305 |doi=10.1016/S1474-4422(13)70294-1 |pmid=24556007|url=https://archive-ouverte.unige.ch/unige:95940 }}</ref> Though first developed for Parkinsonian tremor, the technology has since been adapted to a wide variety of chronic neurologic disorders.<ref name ="Lozano 2017">{{cite journal |last1=Lozano |first1=AM |last2=Hutchison |first2=WD |last3=Kalia |first3=SK |title=What Have We Learned About Movement Disorders from Functional Neurosurgery? |journal=Annual Review of Neuroscience |date=25 July 2017 |volume=40 |pages=453–477 |doi=10.1146/annurev-neuro-070815-013906 |pmid=28772097}}</ref>

The usage of electrical stimulation to treat neurologic disorders dates back thousands of years to [[ancient Greece]] and [[Early Dynastic Period (Egypt)|dynastic Egypt]]. The distinguishing feature of DBS, however, is that by taking advantage of the portability of [[lithium-ion battery]] technology, it is able to be used long term without the patient having to be [[Electrical wiring|hardwired]] to a [[AC power plugs and sockets|stationary]] [[mains electricity|energy source]]. This has given it far more practical therapeutic application as compared its earlier non mobile predecessors.<ref>{{cite journal |last1=Benabid |first1=AL |last2=Pollak |first2=P |last3=Louveau |first3=A |last4=Henry |first4=S |last5=de Rougemont |first5=J |title=Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. |journal=Applied Neurophysiology |date=1987 |volume=50 |issue=1–6 |pages=344–6 |doi=10.1159/000100803 |pmid=3329873}}</ref>

The exact mechanisms of DBS are complex and not fully understood, though it is thought to mimic the effects of [[lesioning]] by disrupting pathologically elevated and oversynchronized informational flow in misfiring brain networks.<ref name="García Pearlmutter Wellstead Middleton 2013">{{cite journal | vauthors = García MR, Pearlmutter BA, Wellstead PE, Middleton RH | title = A slow axon antidromic blockade hypothesis for tremor reduction via deep brain stimulation | journal = PLOS ONE | volume = 8 | issue = 9 | pages = e73456 | date = 16 September 2013 | pmid = 24066049 | pmc = 3774723 | doi = 10.1371/journal.pone.0073456 | doi-access = free | bibcode = 2013PLoSO...873456G }}</ref><ref name=":5">{{Cite journal |last1=Hollunder |first1=Barbara |date=March 2024 |title=Mapping dysfunctional circuits in the frontal cortex using deep brain stimulation |journal=Nature Neuroscience |language=en |volume=27 |issue=3 |pages=573–586 |doi=10.1038/s41593-024-01570-1 |issn=1097-6256 |pmc=10917675 |pmid=38388734}}</ref><ref name=":6">{{Cite journal |last1=Grill |first1=Warren M. |date=May 2004 |title=Deep brain stimulation creates an informational lesion of the stimulated nucleus |url=http://journals.lww.com/00001756-200405190-00011 |journal=NeuroReport |language=en |volume=15 |issue=7 |pages=1137–1140 |doi=10.1097/00001756-200405190-00011 |pmid=15129161|url-access=subscription }}</ref> As opposed to permanent ablation, the effect can be reversed by turning off the DBS device.<ref name=":4">{{cite book |title=Parkinson's Disease and Related Disorders, Part II |vauthors=Morris JG, Owler B, Hely MA, Fung VS |year=2007 |isbn=978-0-444-52893-3 |series=Handbook of Clinical Neurology |volume=84 |pages=459–478 |chapter=Hydrocephalus and structural lesions |doi=10.1016/S0072-9752(07)84055-3 |oclc=1132129865 |pmid=18808964}}</ref> Common targets include the globus pallidus, [[ventral nuclear group]] of the [[thalamus]], [[internal capsule]] and [[subthalamic nucleus]]. It is one of few neurosurgical procedures that allows [[Blind experiment|blinded studies]],<ref name=Kringelbach>{{cite journal | vauthors = Kringelbach ML, Jenkinson N, Owen SL, Aziz TZ | title = Translational principles of deep brain stimulation | journal = Nature Reviews. Neuroscience | volume = 8 | issue = 8 | pages = 623–635 | date = August 2007 | pmid = 17637800 | doi = 10.1038/nrn2196 | s2cid = 147427108 }}</ref> though most studies to date have not taken advantage of this discriminant.<ref>{{cite journal |last1=Bucur |first1=M |last2=Papagno |first2=C |title=Deep Brain Stimulation in Parkinson Disease: A Meta-analysis of the Long-term Neuropsychological Outcomes. |journal=Neuropsychology Review |date=June 2023 |volume=33 |issue=2 |pages=307–346 |doi=10.1007/s11065-022-09540-9 |pmid=35318587|pmc=10148791 }}</ref>

Since its introduction in the late 1980s, DBS has become the major research hotspot for surgical treatment of tremor in Parkinson's disease,<ref name="Hotspot">{{cite journal |last1=Zeng |first1=J |last2=Chu |first2=H |last3=Lu |first3=Y |last4=Xiao |first4=X |last5=Lu |first5=L |last6=Li |first6=J |last7=Lai |first7=G |last8=Li |first8=L |last9=Lu |first9=L |last10=Xu |first10=N |last11=Wang |first11=S |title=Research status and hotspots in the surgical treatment of tremor in Parkinson's disease from 2002 to 2022: a bibliometric and visualization analysis. |journal=Frontiers in Aging Neuroscience |date=2023 |volume=15 |page=1157443 |doi=10.3389/fnagi.2023.1157443 |doi-access=free |pmid=37829141|pmc=10565824 }}</ref> and the preferred surgical treatment for Parkinson's, essential tremor and dystonia. Its indications have since extended to include [[obsessive-compulsive disorder]], refractory [[epilepsy]], chronic pain, [[Tourette's syndrome]], and [[cluster headache]].<ref name = "Complications 2017">{{cite journal |last1=Jitkritsadakul |first1=O |last2=Bhidayasiri |first2=R |last3=Kalia |first3=SK |last4=Hodaie |first4=M |last5=Lozano |first5=AM |last6=Fasano |first6=A |title=Systematic review of hardware-related complications of Deep Brain Stimulation: Do new indications pose an increased risk? |journal=Brain Stimulation |date=September 2017 |volume=10 |issue=5 |pages=967–976 |doi=10.1016/j.brs.2017.07.003 |pmid=28739219}}</ref> In the past three decades, more than 244,000 patients worldwide have
been implanted with DBS.<ref>{{cite journal |last1=Sandoval-Pistorius |first1=SS |last2=Hacker |first2=ML |last3=Waters |first3=AC |last4=Wang |first4=J |last5=Provenza |first5=NR |last6=de Hemptinne |first6=C |last7=Johnson |first7=KA |last8=Morrison |first8=MA |last9=Cernera |first9=S |title=Advances in Deep Brain Stimulation: From Mechanisms to Applications. |journal=The Journal of Neuroscience |date=8 November 2023 |volume=43 |issue=45 |pages=7575–7586 |doi=10.1523/JNEUROSCI.1427-23.2023 |pmid=37940596|pmc=10634582 }}</ref><ref name = "Embo 2019">{{cite journal |last1=Jakobs |first1=M |last2=Fomenko |first2=A |last3=Lozano |first3=AM |last4=Kiening |first4=KL |title=Cellular, molecular, and clinical mechanisms of action of deep brain stimulation-a systematic review on established indications and outlook on future developments. |journal=EMBO Molecular Medicine |date=April 2019 |volume=11 |issue=4 |doi=10.15252/emmm.201809575 |pmid=30862663|pmc=6460356 }}</ref>

DBS has been approved by the [[Food and Drug Administration]] as a treatment for essential and Parkinsonian tremor since 1997 and for Parkinson's disease since 2002.<ref name=":0">{{Cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm451152.htm|archive-url=https://web.archive.org/web/20150614085543/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm451152.htm|url-status=dead|archive-date=June 14, 2015|title= FDA approves brain implant to help reduce Parkinson's disease and essential tremor symptoms|website=FDA|access-date=May 23, 2016|quote=The first device, Medtronic's Activa Deep Brain Stimulation Therapy System, was approved in 1997 for tremor associated with essential tremor and Parkinson's disease.}}</ref> It was approved as a humanitarian device exemption for [[dystonia]] in 2003,<ref name=":1">{{cite news | vauthors = Phillips S |title='Brain pacemaker' for a rare disorder |url=https://www.nbcnews.com/id/wbna19265007 |archive-url=https://web.archive.org/web/20210428014405/https://www.nbcnews.com/id/wbna19265007 |archive-date=April 28, 2021 |work=NBC News |date=17 June 2007 }}</ref> obsessive–compulsive disorder (OCD) in 2009<ref name=":3">{{cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149529.htm|archive-url=https://web.archive.org/web/20090710091416/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149529.htm|url-status=dead|archive-date=July 10, 2009|title=FDA Approves Humanitarian Device Exemption for Deep Brain Stimulator for Severe Obsessive-Compulsive Disorder|work=FDA}}</ref> and [[epilepsy]] in 2018.<ref name=":2">{{cite press release |title=Medtronic Receives FDA Approval for Deep Brain Stimulation Therapy for Medically Refractory Epilepsy |url=https://news.medtronic.com/2018-05-01-Medtronic-Receives-FDA-Approval-for-Deep-Brain-Stimulation-Therapy-for-Medically-Refractory-Epilepsy |publisher=Medtronic |date=1 May 2018 }}</ref><ref name=gildenberg>{{cite journal | vauthors = Gildenberg PL | title = Evolution of neuromodulation | journal = Stereotactic and Functional Neurosurgery | volume = 83 | issue = 2–3 | pages = 71–79 | date = 2005 | pmid = 16006778 | doi = 10.1159/000086865 | s2cid = 20234898 }}</ref> DBS has been studied in clinical trials as a potential treatment for [[chronic pain]], affective disorders, [[major depressive disorder|depression]], [[Alzheimer's disease]] and [[drug addiction]], amongst others.