History of DBS

Deep brain stimulation (DBS = DEEP BRAIN STIMULATION) A little history...

Hello everyone,

I am happy to open the blog on DBS for Parkinson's to the members of the association.

Following on from an expert panel that also included DBS treatment and that was held last month, I thought I'd start by describing the development of this technology.

The first neurosurgical operations for movement disorders began at the beginning of the 20th century and included burning (destruction of areas) of the motor system (a system that controls the activation of the muscles), with the thought that the weakening of the muscles would also lead to a decrease in the motor symptoms of Parkinson's (tremor, slowness, stiffness).

As a result of severe and unwanted side effects of damage to the motor system and discoveries that led to a better understanding of the role of deeper structures in the brain. In the 40's of the last century, surgeries called "stereotactic surgeries" were developed in which a framework is used that helps the surgeon to reach with the help of depth electrodes a desired area of ​​the brain (in the case of Parkinson's disease, at first, this meant the area known as the "basal nuclei"). During the surgery, the electrodes record brain electrical activity patterns that help differentiate between neighboring areas of the brain, later the electrodes transmit an electric current (burn/ablation) to the target area (ie the area in the basal ganglia that causes tremors, slowness and stiffness) in order to create permanent damage there.

The development of effective drug treatment for Parkinson's disease using levodopa led to an extreme decrease in the number of surgical procedures for the indication of Parkinson's during the 70s with the thought that compared to surgery, treatment with levodopa is not expensive, much safer and very effective in improving Parkinson's symptoms.

However, in the 80s, the recognition of the limitations of long-term drug treatment (motor volatility, dyskinesia) along with scientific and technological development that included: improved imaging methods, a better understanding of the brain's function in Parkinson's disease and, as a result, the identification of better anatomical targets (brain areas) for neurosurgical treatment , raised again the horn of the surgical treatment.

The technological progress was partly due to the development of pacemakers for other purposes in medicine, for example: a pacemaker in cardiology. The use of a pacemaker (an energy source that transmits an electric current) in neurosurgery began in the field of treating uncontrollable pain and later moved to other fields in neurology (such as Parkinson's and movement disorders).

The advancement of knowledge in the structure and function of the basal ganglia, which are responsible for the symptoms of Parkinson's disease, received momentum as a result of the development of a model of Parkinson's disease in animals.

At the same time as these developments, several groups of neurosurgeons and researchers in the world, the most famous of which is a French neurosurgeon named Alice Louis Benavid, noticed a new phenomenon. During surgery to treat primary tremor or Parkinson's, when the brain electrodes passed a low-intensity electric current (= deep brain stimulation that does not cause permanent damage to areas of the brain) and with high frequency, a significant improvement in tremor or other motor Parkinson's symptoms was achieved.

A group of researchers led by Benavid used this method of delivering a low-intensity electric current to treat persistent pain and began adopting it with increasing frequency to treat primary tremor or Parkinson's from about 1987. The same French group began to conduct controlled clinical studies in deep brain stimulation for Parkinson's and primary tremor and the results of the studies indicated a significant improvement until the tremor disappeared completely in the patients.

From here the road is short to further studies that have indeed shown that deep brain stimulation treatment for Parkinson's is an effective treatment and with safety that is getting better and better for Parkinson's patients.

In 1987, unilateral brain pacemaker treatment was approved by the US FDA for the treatment of Parkinson's disease with severe tremors. In 2002, when the safety profile of the treatment was proven, the FDA approved the treatment for other Parkinson's conditions that include not only severe tremors.

The field of deep brain stimulation for the treatment of Parkinson's continues to advance and improve all the time in terms of accuracy in imaging, in locating the brain areas during surgery and after surgery, in the hardware related to the brain pacemaker (electrodes, battery), in the software used for the pacing itself, and more.

In the following posts I will refer more to the rationing process, to the areas of the brain that are involved in rationing and to developments in hardware and software.

Sources:

Deep brain stimulation: An overview of history, methods, and future developments. Laurie Pycroft, John Stein and Tipu Aziz. Brain and Neuroscience Advances. 2018; Volume 2: 1–6.

A history of deep brain stimulation: Technological innovation and the role of clinical assessment tools. John Gardner. Social Studies of Science. 2013; 43(5) 707–728

The History and Future of Deep Brain Stimulation Jason M. Schwalb and Clement Hamani. Neurotherapeutics: The Journal of the American Society for Experimental EuroTherapeutics. Vol. 5, 3–13, January 2008