Deep Brain Stimulation Flashcards
Deep brain stimulation
Stimulating electrodes placed surgically into deep brain structures and connected to implanted pulse generator
Which conditions is DBS funded for by the NHS
Parkinson’s
Essential tremor
Dystonia
Which conditions does the NHS fund DBS on a case by case basis
Epilepsy
Chronic neuropathic pain
Essential tremor
Brain disorder causing parts of body to tremor uncontrollably
Dystonia
Brain disorder with sustained or repetitive muscle contractions resulting in twisting and repetitive movements or abnormal fixed postures
Parkinson’s DBS criteria
Idiopathic PD
4 classical symtoms
No sensory issues, weakness, or hyperreflexia
No brain abnormalities/tumours
No mental disorders
Levodopa responsive
Fit for surgery
Realistic surgery expectation
Which PD symtoms can DBS treat
Motor
How is DBS electrode target site identified
MRI
How long between insertion and programming of electrode
1 month
Results of DBS in PD
Increase on time
Decr bradykinesia, rigidity, tremor
Decr drug doses needed
DBS targets for PD, tremor, and Dystonia
Zona incerta tremor
Subthalamic nucleus tremor
Globus pallidus internus tremor+Dystonia
DBS target for epilepsy
Anterior nucleus of thalamus
DBS target for theraoy refractory OCD
nucleus accumbens
Ventral striatum
Treatment resistant major depressive disorder DBS targets
Subcallosal cingluate - brodmann 25
Nucleus accumbens
Addiction DBS target
Nucleus accumbens
Is DBS reversible
Yes
Is DBS long or short term treatment
Long term
24 hr control for years
DBS risks
Brain haemorrhage
CSF leakage
Transplantation problems - infection, allergy to implant
Temporary tingling, balance loss, dizziness, concentration issues
Migration of electrode
Rebound when stimulus stopped
May not effect pt
4 hypothesised DBS MOA
Inhibition hypothesis
Excitation hypothesis
Disruption hypothesis
Neuro network modulation hypothesis
DBS inhibition hypothesis
DBS blocks spontaneous discharge of overactive neurones
DBS excitation hypothesis
DBS excites afferent axons ‘jamming’ spontaneous neurone activity
DBS disruption hypothesis
DBS disrupts abnormal information flow by dissociating inputs and outputs
DBS Neuro network modulation hypothesis
DBS causes neuroplasticity
How does DBS affect disease
Modify or slow progression
Cannot cure
