The operation is Wednesday. Patient 005 is having a deep brain stimulation device implanted on Wednesday, give him some support, here: DBS Trial
Deep Brain Stimulation
Recently I found a hands on experience blog for someone undergoing deep brain stimulation for parkinson’s disease. Now another blogger who blogs about the participation in a trial: 278-005 DBS Trial. This trial is done in St. Jude’s. It’s the DBS study for TRD (treatment resistant depression). Surgery is scheduled for next week.
The trial is a blind study – which means I won’t know if the gizmo they give me is turned on or not. At least for 6 months I won’t know. from what I understand 2 out of 3 of the gizmos implanted will be turned on. The other 1/3 won’t be turned on for 6 months and NONE of us will know which one we are.
There is a new blog with the written hands on experience of undergoing deep brain stimulation surgery: Focus on a Cure’s Deep Brain Stimulation (DBS) Journal
This blog is created in the hopes that my experiences will give others inspiration to take a risk and have the courage to face the unknown in order to accomplish the impossible as others have done for me.
Incredible good insight and information about the whole procedure, especially the whole process before deciding to undergo the procedure.
One thing I was surprised about that after all my research and all my conversations with other DBS patients and doctors no one mentioned the steel ball ear plug portion of the halo/frame procedure. During this portion I asked the surgeon why no one ever mentioned this part he told me it was because most people do not remember it. Well let me be truthful I remember ever second of it and I told him I was going blog about it and let the secret out.
On this blog plenty of posts about the use and indications for Deep Brain Stimulation and on Mind Hacks a short list of things that deep brain stimulation has been used to treat.
Thanks Jan at Medblog.nl
In Deep Brain Stimulation for treatment resistant depression with stimulation of Broadman area 25 (Cg 25) no consistent declines in memory for either verbal or visual material were noted after onset or maintenance of DBS over baseline. This makes DBS a procedure with out apparent cognitive side effects in treatment resistant depression. In a recent publication with DBS in the Subthalamic Nucleus for treatment resistant Obsessive Compulsive Disorder (OCD) no cognitive decline was found. The ratings of neuropsychological measures were not modified by stimulation.
In 17 patients participating in this 10-month, crossover, double-blind, multicenter study assessing the efficacy and safety of stimulation of the subthalamic nucleus one patient had a parenchymal brain hemorrhage (bleeding) resulting in a permanent finger palsy. Two patients had an infection leading to removal of the pulse generator. Seven transient motor and psychiatric symptoms induced by active stimulation occurred in the first month of stimulation and resolved spontaneously or rapidly after adjustment of the setting. Ten other patients also had serious but transient side-effects.Three patients became hypomanic, three suffered from anxiety, two of depressive symptomps the others suffered from transient neurological side-effects such as dyskinesia, trouble walking, dysarthria, dysphagia and facial asymmetry.
Deep Brain Stimulation of the subthalamic nucleus significantly reduced the symptoms of severe forms of OCD.
In conclusion, findings from this 3-month crossover study suggest that stimulation of the subthalamic nucleus may lessen the severity of obsessive–compulsive symptoms and improve global functioning in patients with refractory, severe OCD. Serious adverse events occurred in 11 of the 17 patients in whom stimulators were implanted. The occurrence of severe adverse events, the small number of patients, and the short duration of the study highlight the risks of stimulation of the subthalamic nucleus and the need for larger studies with longer follow-up. In addition to assessment in a larger number of patients, a comparison with other stimulation targets and surgical procedures would be desirable, as would an evaluation of the long-term benefits of stimulation of the subthalamic nucleus in patients with OCD, notably with respect to their quality of life and their ability to function in social and work environments.
With the expanding knowledge of the neuronal circuits responsible for the behavioral disorders associated with addiction, though, DBS could become a future treatment option for patients suffering from addiction and being part of an Addiction Recovery Therapy.
In people addicted to psychoactive substance it has been shown by Positron emission tomography studies that, when they take the psychoactive substance, dopamine is released in the nucleus accumbens, which causes “the high.”
They lack the decrease of the output neurons on this dopamine release. There is no brake on the “high” elicited by the drug and the subsequent dopamine release. This lack of inhibition causes activation of the reward system. The increased dopamine release is located in the nucleus accumbens. This reward circuit consists of dopaminergic neurons that project from the ventral tegmental area to the ventral striatum (including nucleus accumbens), the amygdala and septal nuclei, and prefrontal and cingulate cortices.
The feeling of well-being produced by activation of the reward system can be seen as positive reinforcement. Negative reinforcement involves escaping from or avoiding intensive outpatient treatment symptoms, which occur after cessation of the substance use. In addicted individuals both positive and negative reinforcement involve disruption of the reward system by repeated administration of the substance.
Other brain regions involved in addiction are:
- The amygdala. The amygdala couples the rewarding qualities of the substance and the environment in which the abuse takes place. This could explain why an environment with substance-
associated stimuli causes the craving reported by addicted individuals
- The prefrontal cortex and the anterior cingulate gyrus. Dysfunction of the dopaminergic transmission in these structures leads to impairment of inhibitory control and decision making. This may cause an inability to resist substance-abusing behavior in addicted individuals, even
though they are explicitly aware of the negative consequences.
A recent review described the different psychosurgical procedures used in an addiction treatment clinic as treatments. Moreover this review also discusses the first reports on the treatment of substance-related addictive disorders by using Deep Brain Stimulation.
They found three cases in two publications. Two patients with Parkinson’s disease and Dopamine dysregulation syndrome.
Dopaminergic medications, share some of the stimulant properties of commonly abused drugs such as amphetamine and cocaine. These have the potential to be compulsively used by a small group of susceptible individuals with Parkinson’s disease, causing harmful social, psychological, and physical effects. Patients with this condition, termed “dopamine dysregulation syndrome”, meet clinical criteria for substance dependence and addiction. They frequently also show behavioural compulsions, such as compulsive gambling, eating and hyper-sexuality.
In both cases there was a good effect of deep brain stimulation on motor disability, but also on Dopamine Dysregulation Syndrome and related behavior characteristics. They both underwent bilateral subthalamic nucleus deep brain stimulation. The other case report was about a man with severe agoraphobia with panic attacks, secondary depressive disorder, and alcohol dependency. After bilateral deep brain stimulation of the nucleus accumbens the substance abuse disappeared. The nucleus accumbens is part of the “addictive circuit” in the brain.
Psychosurgery for the Newport Beach Addiction Treatment has been done and published. Never in randomized controlled trials and the procedure is irreversible.
DBS is reversible and makes randomized placebo controlled trials for this indication feasible. Nevertheless, the evidence so far is circumstantial and limited
What do you think, should DBS be tried with addiction?
Bianca M. L. Stelten, Lieke H. M. Noblesse, Linda Ackermans, Yasin Temel, Veerle Visser-Vandewalle (2008). The neurosurgical treatment of addiction Neurosurgical FOCUS, 25 (1) DOI: 10.3171/FOC/2008/25/7/E5
Deep brain stimulation has shown promise in the treatment of treatment resistant depression(TRD) in some small series and case reports. The definition of TRD is still a matter of debate. There isn’t one clear classification scheme of TRD. TRD shouldn’t be mixed up with pseudoresistant depression . The recent research with deep brain stimulation showed some promising results and in the future might add this treatment to the 9 steps for treatment resistant depression.
Since this treatment for TRD is in it’s infancy
The most appropriate target, optimal stimulation parameters, and long-term effects and efficacy remain uncertain.
About the targets for deep brain stimulation in treatment resistant depression some options are available:
- The reward circuitry of the ventral striatum and Nucleus Accumbens has been associated with drug addiction and depression for many years. Some case reports showed some partial effect on TRD. One case report with obsessive-compulsive disorder and concomitant major
depression and three cases with TRD.
- Subgenual Cingulate Cortex: Area 25. Helen Mayberg found the switch that lifts depression in area 25, a spot deep in the cortex. This area is the key conduit of neural traffic between the thinking frontal cortex or forebrain and the central limbic region that plays a role in emotions and which appeared earlier in our evolutionary development. This area is overactive during depression or sadness. This form of DBS was doen in a Randomized Controlled Trial with 6 patients with overall response of 60%.
- Inferior Thalamic Peduncle. The ITP has proven to be hyperactive in depression, a phenomenon that reverses with effective pharmacological treatment. Successful use of this target in DBS stimulation has been published in one case report. One initial case report indicates promise, large-scale trials of implantation are necessary to determine the efficacy and safety of this target.
- Rostral Cingulate Cortex: Area 24a. No electrode has yet been implanted in the rostral cingulate cortex in humans; however, stereotactic lesioning of this area has shown beneficial effects.
- Lateral Habenula. Only used in animal models with some suggestion that functional inhibition of this area using high-frequency DBS may have therapeutic benefit
These localizations have been described on this blog in another posts: 5 different locations for deep brain stimulation in depression, but now it appears in a peer reviewed article with excelent graphics.
Only three have been tried with patients with TRD or obsessive-compulsive disorder and concomitant major depression. The other anatomical targets are tentative. The most impressive results done with a proper study design was with Broadman area 25 by Helen Mayberg.
I think the following quote by Dr. Cosgrove sums it up as far as the progress and future of DBS is concerned:
“deep brain stimulation may provide a unique opportunity to help patients who suffer horribly from the consequences of severe depression…. early efforts must go forward only with the highest ethical, moral, and scientific standards to ensure that this historic opportunity is not wasted…. much is at stake.”
What do you think?
Jason S. Hauptman, Antonio A. F. DeSalles, Randall Espinoza, Mark Sedrak, Warren Ishida (2008). Potential surgical targets for deep brain stimulation in treatment-resistant depression Neurosurgical FOCUS, 25 (1) DOI: 10.3171/FOC/2008/25/7/E3
CNN’s Dr. Sanjay Gupta reports on new research showing deep brain stimulation may ease severe depression.
In a very short video a short introduction to Deep Brain Stimulation with nice animation. It is explained as a pacemaker to the brain. The pacemaker regulates mood circuits, potentially easing deep depression no other treatments can touch. Also about who are candidates for this treatment. Answer: When all else fails.
Alas the video is not always available or other technical problems exist.
The current study is the largest clinical trial to date of the efficacy of DBS as a treatment for severe depression. Between May 2003 and November 2006, Andrez M. Lozano and his colleagues implanted electrodes into the brains of a total of 20 patients (9 men and 11 women) with major depressive disorder, all of whom were referred to the researchers from hospitals or community psychiatrists, after failing to respond to antidepressants, psychotherapy or electroconvulsive therapy.
On Neurophilosophy a post about this new trial with this new treatment for treatment resistant depression.
12 out of the 20 patients reported significant long-term improvements in their condition. This was corroborated by neuropsychological assessments which measured, among other things, the patients’ mood, anxiety levels and sleeping patterns. These improvements were observed within 1 month and, importantly, persisted for at least 12 months after the treatment, by which time 7 of the patients had gone into full remission.
Time for some randomized controlled trial with switching on and off?
Related posts on this blog about Deep Brain Stimulation
Info about deep brain stimulation and research about deep brain stimulation of the Cleveland Clinic
Patients may be appropriate candidates for investigational studies into deep brain stimulation for depression if they meet the following criteria. (They should know that the procedure is invasive and only experimental at this point.)
1) have a diagnosis of major depression (bipolar patients are not currently being enrolled)
2) have had the illness for at least five years and are significantly disabled by it
3) current episode of depression has lasted for at least two years
4) has failed at least four trials of antidepressants (at least two different classes) as well as augmentation with at least two agents known to be effective in this group (lithium, thyroid, antipsychotics, stimulants)
5) no psychotic symptoms outside of an episode of depression (patient cannot currently be psychotic)
6) no severe personality disorder present which would interfere with safety or compliance
7) past treatment with ECT to which the patient has either been refractory or intolerant
8) ability to comply with study demands (monthly visits, prolonged testing visits, etc.)
Technology Review: Brain Electrodes Help Treat Depression
Electrically stimulating specific parts of the brain using an implanted electrode can help severely depressed patients, according to two studies published this month. The findings are the latest evidence suggesting that “deep brain stimulation,” a surgical therapy already widely used to treat Parkinson’s disease, could be an alternative treatment for people with severe depression. Vaping is a great way to treat depression, take a look at this review.
There are also many ways to treat depression, unconventional for some, like the use of CBD oil, as many research says that it has a positive reaction and interaction with serotonin receptors in the brain, according to medcardnow.com you can get your med car to have a discount on any cannabis item, it impacts the emotional state and the feeling of being happy. This is used as therapy and not only for this disease but also for anxiety, cancer patients, glaucoma, and parkinson which is still on many studies but all had come out positive. can CBD oil help Parkinson’s? many ask themselves and to their doctors this question and research says it does, depending on the patient symptoms and how it affects him it can actually help the body in a huge percentage.
CBD Oil Basics
CBD is short for cannabidiol, a chemical compound found within the cannabis plant that binds to cannabinoid receptors located in the body’s endocannabinoid system.
CBD is different than other cannabinoids found in the marijuana plant that are known for producing the high commonly associated with medical marijuana use. This includes tetrahydrocannabinol (THC) and a similar cannabinoid, tetrahydrocannabivarin (THCV). Both THC and THCV can produce this high effect, whereas CBD does not. Cheef botanicals offer many types of CBD products — including capsules, full spectrum CBD oil drops, edibles, vegan CBD gummies, top-shelf flower, topicals and much more! Our capsules are vegan, organic, natural and infused with quality, full-spectrum hemp CBD.Full spectrum CBD oil is CBD plus. You can take a look at the label on any over-the-counter pain reliever and you can easily figure out how much you’re supposed to take for your symptoms. Finding the right dose of cannabidiol (CBD) for pain relief, however, isn’t that simple.Enthusiasts rave about CBD’s potential to ease pain, reduce inflammation, relieve anxiety and promote sleep. However, there’s no conclusive research about just how much CBD a person needs to take in order to experience benefits.There are very few human studies on CBD, and those that have been done include doses that are all over the map: In some studies, patients used 5 mg of CBD; in others, they took as much as 600 mg. To further add to the confusion, CBD comes in a number of forms — oils and tinctures, creams and lotions, pills, vaping, and edibles — and each one has differences in terms of bioavailability (the percent of active ingredient that gets into your bloodstream).
Additionally, our bodies do produce some cannabinoids on its own. These are called endogenous cannabinoids because they are so similar to cannabis plant compounds. CBD from Global Cannabinoids works by mimicking and augmenting these natural cannabinoids, providing a more therapeutic effect.
Admittedly, information in this field is still emerging, primarily because the endocannabinoid system is a relatively new finding due to the first endocannabinoid not being discovered until 1992.
After the second one was identified three years later, researchers began to realize that the human body has an entire endocannabinoid system that offers positive effects related to bone density and diabetes prevention.
Since that time, research has also connected CBD with providing benefits for Parkinson’s disease.
CBD Oil Legalities
One of the major concerns patients have with the use of CBD oil is whether or not it is legal. Psychology Today stresses that, while many people think that the passing of the 2018 Farm Bill legalized CBD federally, this isn’t exactly the case.
Instead, the Farm Bill only legalized hemp, which is the fibrous stalk of the marijuana plant. Technically, all other parts of the plant are still illegal under the Controlled Substances Act.
What confuses the issue even more is that each state has set its own statutes regarding hemp, medical marijuana, and CBD. For instance, in New York, patients can smoke cannabis, but they aren’t banned from accessing it as a dried flower. However, if you live in Colorado, not only can individuals use medical cannabis, but children can even legally possess it on school campuses if they have status as a medical cannabis patient.
Because of these variations, it is always recommended that Parkinson’s patients check the legality of cannabis use or CBD oil in their individual states before utilizing this option for treatment purposes, i49.net can help you get further information.
Still, experts urge caution in interpreting the results. For one thing, says Karl Deisseroth, a psychiatrist at Stanford who studies experimental treatments for depression, “no placebo-controlled trials have been done” to confirm how well the therapy works on a larger population.Doctors involved in the studies caution that larger clinical trials are needed to determine how effective and long-lasting the therapy is.