Deep brain stimulation

Electrical stimulation of the brain is an important therapy for refractory neurological disorders such as drug resistant Parkinson's disease and severe tremor and has become an area of active clinical research in both neurology and psychiatry. Using a technique called deep brain stimulation (DBS), small electrical leads are placed into the brain using stereotactic localization. A special head frame is attached to the skull under local anesthesia, and electrodes are implanted using internal brain targets located with reference to anatomical landmarks determined by brain imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). This technique allows for the precise targeting of specific brain sites or nuclei. Insertion of electrodes can be done without damage to adjacent tissue. These electrodes are connected by a wire to a pacemaker implanted in the chest that generates electrical stimulation. Stimulation parameters can be modified by manipulation of the pacemaker.

Unlike ablative surgery that results in irreversible damage of brain tissue from the intentional destruction of targeted areas, the effects of DBS are reversible. The stimulator can be turned off, and the electrodes can generally be removed without any significant aftereffects. DBS differs from other methods that employ electrical stimulation of the central nervous system. Electroconvulsive therapy (ECT), primarily used to treat severe depression, stimulates the brain using electrodes placed on the scalp. Transcranial magnetic stimulation induces electrical currents in the brain using external magnetic coils. Electrical stimulation in the neck of the vagus nerve has been demonstrated to reduce epileptic seizures. Cortical stimulation of the brain is also employed as a treatment for chronic pain disorders (Greenberg).

Electrical stimulation of the brain is also used as a diagnostic tool in the treatment of epilepsy and as a means to localize specific brain areas in order to avoid injury during surgical procedures. Electrical stimulation has also been applied within the peripheral nervous system for neuroprosthethic applications such as reconstituting motor function in a paralyzed limb.

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