Deep Brain Stimulation

A Pacemaker for the Brain

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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