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Tuesday, July 8, 2008

Neurostimulation update

On Medpage today a summary of a variety of alternative approaches that apply electrical currents to the brain are in the research pipeline, and one is FDA approved. A summary of VNS, rTMS, magnetic seizure therapy, deep brain stimulation , TDCS and Implantable cortical stimulation. Never heard of that last one, a new form of neurostimulation?

Implantable cortical stimulation

Another early-stage investigational technology takes vagus nerve stimulation a step farther. Instead of delivering electrical pulses to a nerve, it sends them to the surface of the brain. Seattle-based Northstar Neurosciences is testing a system that, like vagus nerve stimulation, inserts a pulse generator in the patient's chest. An electrical lead is passed into the skull through a surgically drilled hole, terminating on the dural membrane over the cortex.

A nice overview.

On Psych Central: Brain Pacemaker Shows Potential
A short description of the history of deep brain stimulation and two case reports with exceptional indications for deep brain stimulation: one patient was treated for body dysmorphic disorder and the other was treated for debilitating headaches.
Body dysmorphic disorder is excessive preoccupation with minor or imagined flaws in appearance. Dr. Anderson’s patient was a 20-year-old man who obsessed on perceived flaws with his nose and other facial features. He had attempted suicide once, and described his life as a “living hell.” Eight months after DBS surgery, the patient reported mild depression and obsessive compulsive disorder, but no symptoms of body dysmorphic disorder.
The second patient was a 43-year-old woman who suffered paroxysmal hemicrania headaches around the orbit of her right eye. She would typically get 10 to 20 attacks per day, each lasting 2 to 20 minutes. The headaches did not respond to either medications or a nerve block. But as soon as the DBS device was turned on, the woman reported the pain went away.

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