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A boy walks down a hospital corridor. He
swings his arms. His gait is perfectly unremarkable. And that's remarkable.
Because a few weeks earlier, he'd been unable to walk at all. The difference
between then and now is a remarkable new surgical procedure that has been
likened to implanting a "pacemaker" in the brain.
They call the procedure deep brain
stimulation (DBS). It's working wonders for patients with Parkinson's and
other movement disorders such as essential tremor and dystonia. But doctors at
The Cleveland Clinic have even higher hopes for DBS. They believe that in
coming years, it may prove to be an effective treatment for an astonishing
range of conditions. Not only Parkinson's, but multiple sclerosis, epilepsy,
chronic pain, obsessive compulsive disorder -- even depression.
"Now is an exciting time," says
Ali R. Rezai, M.D., co-director of the Center for Functional and Restorative
Neuroscience at The Cleveland Clinic. "Our team is redefining
neurosurgery for the future."
Dr. Rezai is one of a new breed of
neurosurgeons called a functional neurosurgeon, who treats disabling disorders
with sophisticated computer equipment.
"The brain pacemaker is the
state-of-the-art in medical engineering," says Dr. Rezai. "Once it
is implanted, it emits finely tuned pulses of energy that relieve symptoms
without the cell damage and destruction associated with traditional brain
surgery. The pacemakers can be reprogrammed to adjust to any change in the
patient's condition or to progression of symptoms that may occur over time. It
is a dynamic therapy. Stimulation settings can be modified to maximize symptom
reduction while minimizing both complications and side-effects. The procedure
is also completely reversible."
Brain stimulation as a concept has been
around since the 1940s. Only recently, however, have neuroscientists had the
knowledge necessary to put it to use.
"Modern neuroscience research
techniques have revealed the basic mechanisms of the disease process with a
new level of precision," says Dr Rezai. "We now know the exact
location of the abnormalities that cause the tremors of Parkinson's disease or
the seizures of epilepsy. Thanks to advances in three-dimensional computer
guidance and computer-aided brain-mapping technology, surgery is safer and
less invasive than ever before."
Dr. Rezai says that surgeons can target
any structure of the brain with one-millimeter accuracy to identify where
confused or abnormal nerve signals are generated. Such accuracy allows the
surgeons to implant the brain pacemaker's tiny electrode precisely where it is
needed to sooth these minute, chaotic abnormalities.
While it is not a cure, DBS can improve
the quality of life for patients for whom other therapies have failed. In
addition, a number of studies are underway to investigate the possibility that
DBS may slow the progression of Parkinson’s disease.
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