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Issue Date: March 2007

Top Docs DBS

By gently placing the tips of tiny wires — thinner than a human hair — into various areas of a pa-tient’s brain, doctors can treat movement and neurological disorders.

For the past decade, doctors performing deep brain stimulation (DBS) have treated people with Parkin-son’s disease and dystonias by implanting electrodes inside the brain and running wires under the scalp to the collarbone, where a small neurological pacemaker is implanted. Once activated, tiny elec-trical impulses are sent to the targeted brain areas.

Now, the focus is shifting. Patients with severe depression, obsessive-compulsive disorder, Tourette’s syndrome and other ailments may find DBS provides relief, after all other treatments have been ex-hausted.

Using the “minute brain pacemakers,” doctors are “able to shut down abnormal activity and calm the chaos in the brain,” says Dr. Ali R. Rezai, Jane and Lee Seidman chair in functional neurosurgery and di-rector of the Center for Neurological Restoration at Cleveland Clinic, whose team has performed more than a thousand DBS implants on Parkinson’s and dystonia patients. “We can also insert these implants into the brains of people suffering from severe depression and activate the mood areas in the brain with positive results.”

The tremors and often embarrassing vocal tics peculiar to Tourette’s patients have been of special inter-est to Dr. Robert J. Maciunas, professor and vice chair of neurosurgery at University Hospitals Case Medical Center. Four years ago, he successfully treated a longtime sufferer of Tourette’s. The procedure so dra-matically improved the man’s quality of life, he told the world on “Oprah” and “Good Morning America.” The publicity generated thousands of phone calls, triggering a study that began in June 2005 involving similar DBS surgeries for five patients.
“We found we could pinpoint certain cells in the brain that cause disorders,” Maciunas says. “We could selectively turn on or off electrodes and create a field of electroactivity within the brain that has the proper size and shape to match that of the cells we were targeting, and better avoid influencing cells we didn’t want to.”
Most of Maciunas’ Tourette’s patients have experienced considerable improvements without complica-tions from the surgeries. — LVW

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