The Science Behind Deep Brain Stimulation | Hacker News Reader

The Science Behind Deep Brain Stimulation

smithsonianmag.com

35 pointsacdanger13 comments

Here are some quibbles - it's not a "new" surgery. Benabid's first cases were published in 1987 and people have been steadily doing them since. FDA approval was in '01 or so. I think the amount of patients who have received the device is now north of 100k. Medtronic's patent on subthalamic stimulation has now expired, and St. Jude and Boston Scientific are readying competitive devices (and better in many ways, IMHO) for their own device approval trials. (Boston Scientific's device traces its lineage to Al Mann and the cochlear implant, which is a fascinating story in its own right).

It's not even a fancy device in its own right. For the EE folks out there it's just a wire hooked up into a device based off of Medtronic's cardiac pacemakers. It's a square wave that's generated by a capacitor discharge, with some simple bread board inside to allow programming of pulse duration, voltage amplitude, and frequency.

That being said, the effects are indeed fascinating, and no one is sure exactly why it works. The best review papers that I can be gotten if you pubmed Cameron McIntyre, Svetlana Miocinovic, Jerry Vitek, or Phil Starr. There's also an interesting one looking at FFT-generated power spectra taken from measurements during surgery by Cora de Hemptinne which is pretty good.

Mike Okun and Kelly Foote are pretty cool people, though, good to see them getting a shout out.

I posted a "reply" but it wasn't threaded here -- hope you do see my question for you in the main comments. Thanks.

There's some hopeful results from noninvasive variants as well, such as (mentioned once in the article):

https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulat...

Here's the rub - the noninvasive stuff has never had as good symptomatic results. The papers like to find numbers with good statistical significance but in practice, the results from DBS in Parkinson's, and dystonia are impressive, and persistent, while the TMS results have been modest at best, and stop when you turn off the stimulator.

It'd be nice to have a non-invasive device that works just as well but the nice thing about DBS is that it's all internalized and the patient never forgets to turn it on or take it off accidentally...

> There's some hopeful results from noninvasive variants as well

including "transcranial ultrasound stimulation", http://diyhpl.us/~bryan/papers2/neuro/ultrasound/

Now I just need to build myself an ultrasound device that temporarily disables my amygdala, and I can be Paul Muad'Dib.

TDCS also has a pretty active hobbyist community, although I tend to be a little more risk averse than most of its members.

http://www.reddit.com/r/tdcs

@caycep, thank you for such a clear explanation. If you are so inclined as to tweak descriptions of "Neuromodulation_medicine" (an overview by me) or other relevant entries on Wikipedia, I think they need that historical and technical background . . . I tried to create a scaffold there that could be elaborated upon by more knowledgeable folk and would be so happy to spark some contributions of insight to the overview there to make a more robust entry. (I personally found the barrier to entry to trying to edit there was low despite whatever drawbacks we've all heard about.)

I have no idea why the linked article doesn't mention DBS as a treatment for severe depression:

http://www.healthline.com/health/depression/deep-brain-stimu...

Surely an oversight -- there are at least as many people with severe depression as with hand tremors and Parkinsonism.

Probably because it's still experimental - trials are still ongoing at Toronto and Emory, and are still considered in the pilot phase. I don't think more than 40 people have had it done so far, and it's definitely been more inconsistent in terms of effectiveness compared with Parkinsonism. That being said, you're right about the epidemiology - there's a lot of depression (and um....the potential market, which is how Medtronic, the company funding a lot of the studies, is looking at it). The appropriate clinical selection criteria for depression surgery, should it ever get approved by the FDA, will have to be carefully put together...

It does mention depression, but it doesn't go into any great detail.

Hmm.

I'm considering a start-up that would make special EMF field interacting hammers that could be used to reset large scale neuro-networks. Could thing, is that I think these hammers could actually be used on both, biological and silicon computational devices! And considering that it probably would be hard to get an FDA approval [needs about a .1 billion dollars lobbying moneys], at first we can sell as a panacea-fix-it-all solution for Mac Pro, TV Sets and Bimmer owners.

Anyone wants to join?

[in 5 years in a "Science of EMF Hammers article": “Can anyone tell me why this procedure does what it does?” ...

“Well,” says Yllek Etoof, “we know a lot, but not everything.” .... "More than 100,000 people around the world have undergone EMF Hammers since it was first approved, in the 2016s, for the treatment of movement disorders. Today, besides providing relief for people with Parkinson’s disease, dystonia (characterized by involuntary muscl ..... isorder and other neuropsychiatric conditions, as well as early signs that it may improve memory in Alzheimer’s patients.

Suddenly it’s one of the most exciting treatments in modern medicine. With seemingly millions of potential EMF Hammers patients, it’s easy to imagine a future where EMF minihammers may become as common as hip replacements. .... But Nuko says more than 90 percent of their patients rate themselves as “much improved” or “very much improved” on standard postoperative outcome scales.

In the 12 years since they joined forces, Nuko and Etoof have seen EMF Hammers evolve, in Nuko’s words, “from crazy, to kind of cool but not completely accepted, to accepted.” Nuko, 42, recalls: “When I first got hired here, my chief said to me, ‘You’re a nice kid, you’re a polite kid, but don’t embarrass us.’”]

You should see this video to really understand how impressive dbs technology is. Incredible doesn't even begin to describe it. https://www.youtube.com/watch?v=uBh2LxTW0s0

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