New Treatment for Bipolar – What is Deep Brain Stimulation?

Psychosurgery.

Lobotomy.

These words tend to induce fear in even the most rational of people, and with good reason. The idea of someone burning little holes into your brain isn’t for the faint of heart.

And yet this is exactly what evolved into deep brain stimulation – a type of therapy where electrodes are implanted in the brain.

History of Deep Brain Stimulation

Deep brain stimulation was first used in the 1970s to treat chronic pain but poor results and inferior electrode design led to its falling out of favor until 1987 when it was pioneered in France for the treatment of movement disorders. Deep brain stimulation was eventually approved by the Food and Drug Administration (FDA) to treat essential tremor in 1997.

The treatment was developed on monkeys who had been given movement disorders by researchers in the hopes of finding a treatment for Parkinson’s disease and, indeed, the FDA approved deep brain stimulation for the treatment of Parkinson’s in 2002.

Deep brain stimulation was a great leap forward in the surgical treatment of Parkinson’s disease as it does not involve the destruction of brain tissue as previous surgeries for the disease have.

Deep brain stimulation is now being investigated for the treatment of treatment-resistant depression, bipolar disorder, obsessive-compulsive disorder and other disorders, although the FDA has not approved it for any of those uses yet.

Deep Brain Stimulator Implantation

Deep brain stimulation involves the implantation of two thin wires, known as leads, into the brain. The placement of these leads is determined by high-resolution magnetic resonance imaging (MRI) scans in combination with equipment designed to use the scans to create specific brain coordinates for lead placement. The leads, about 1.4 millimeters wide, must hit a location that is a mere fraction of a pea in size.

Lead implantation surgery is done under local anesthetic with the patient awake in order to monitor their behaviors and alter lead placement in response to any changes.

Once the leads are implanted, the pulse generator – the computer that sends out the electrical pulses – is implanted in the chest area while the patient is under a general anesthetic. The leads are fed around the skull, down the neck and attach to the pulse generator in the chest. The implanted pulse generator is controlled by an external programming wand and it is turned on about two weeks after surgery.

The specific mechanism by which deep brain stimulation works is not known.

Up Next…

But the question is: what are the risks, and does deep brain stimulation work for bipolar disorder? 

Find out in my next column, Does Deep Brain Stimulation Work for Bipolar Disorder?