5 of 5 people found the following review helpful:
4.0 out of 5 stars
A new treatment method for brain disease, September 28, 2009
This review is from: Deep Brain Stimulation: A New Treatment Shows Promise in the Most Difficult Cases (Hardcover)
As a student of bioscience, I find this book to be comprehensive in deep brain stimulation (DBS) topic with a simple, but concise understanding. Deep Brain Stimulation by Jamie Talan takes us to the forefront of brain research with an accessible introduction to a new treatment method for disparate brain diseases such as Parkinson's disease, dystonia, obsessive-compulsive disorder, chronic pain, and even states of long-term unconsciousness. This book provides readers with an inside look on the revolutionary technology by tracking history, presenting latest developments from preeminent scientists, and providing firsthand accounts from patients.
The first part of the book describes of pioneers and histories in the DBS research field with Parkinson's disease. Parkinson's disease is one of the best studied brain disorder by the end of twentieth century and has long history with human life. The book shows us many frontiers and their successful researches such as Rolf Hassler and Lauri Laitinen, who are neurosurgeons and focused on thalamus surgery for treatment of Parkinson's tremor, and Irving S. Cooper, who operated on more than five thousands surgery for Parkinson's patients. Even though the results were unsuccessful, these efforts provided a starting point to understand the disease and moved one step closer to the brain regions that are related to Parkinson's tremor.
After some period of this controversy on the frontiers, George C. Cotzias developed a precursor of dopamine called L-dopa. He shows that L-dopa crossed into the brain broke down to form the dopamine needed to restore levels of the chemical to the basal ganglia. This region was normally rich with dopamine, but in the Parkinson's patients, dopamine was depleted from the cells. Over two decades, patients had been relying on L-dopa to treat their symptoms, but the medicine was proving to have its own problems such as on and off fluctuations, and dopamine cells in the brain continued to die away.
The patients unable to benefit in the long-term from L-dopa, it remained for researchers to produce one more series advances that would open the road to DBS. Those advances would emerge from confluence of neurosurgery and revelations from microrecording of brain cells by Dr. Delong. He and his team are focused on microrecorduing of brain and applied pillidotomy to the basal ganglia. They proved that the surgical lesion in the pallidum worked better than medications, reducing symptoms by 30 percent more than the drugs.
In November 1986, Dr. Benabid found that electrical stimulation with high frequency can stop the patient's tremor. When he applied stimulation on STN based on the results of Dr. Delong, he found at least resting tremors had gone. For more than twenty years since the mid-1980s, pioneering leadership-by DeLong, Laitinene, Benabid, and Vitek most notably-had been setting the landmarks by which deep brain stimulation could begin to advance.
For dystonia, researchers have more hard time to figure out the effects of DBS treatment because responding time of DBS treatment is not same as Parkinson's. When they implanted electrode, they can see the results immediately. However, a few months later after patient had a surgery, the patient starts to respond and the symptoms are reduced by more than 50 percent.
People marvel at the concept of DBS when they see someone with advanced Parkinson's, who is no longer jerking and can walk smoothly, or a young boy out playing basketball again after being unable even to sit in a wheelchair without falling to the ground because of dystonia. But then mention that neurosurgeons and neurologists have teamed up with psychiatrists to tackle obsessive-compulsive disorder (OCD), Tourette syndrome, or depression, and there is a look of consternation."Stimulation the brain to alter behavior and mood?" the researchers start with this sentence and notice that such side effects of DBS had been created changes in mood and behaviors. The OCD patients with DBS had improved almost 65 percent on their symptoms. For the Depression and Tourette symdrome, DBS is still not clear because some of patients are getting better but the orders are not. In addition, the brain regions related to these psychiatric disorders are not clear enough. The researchers think DBS does not only activate the output from stimulated structure but also changes the pattern of neuronal activity from a noisy, chaotic signal to a more regular one. This pattern change may be the key to find out DBS for depression and Tourette syndrome, but notes much remain to be done to understand the effects on the network and how it may change with long-term stimulation.
Finally, the author touches the parameters and risks for DBS treatment. DBS techniques have developed for each condition the benefits always have emerged hand in hand with the side effects and the risks. The problem is that DBS is not just a surgery but a technique that needs to be done just right and sometimes adjusting the parameters of the stimulation can take months, or even longer. The neurosurgeon and neurologist have to keep their eyes wide open and look at patients for best treatment with DBS.
After finishing the book, it seems to deserve at least a four out of five star rating, the amount of information gained on major history of DBS and its effects on Parkinson's disease, dystonia, and psychiatric disorders are satisfying. Although the author offers multiple examples to illustrate his point, it is at a great difficulty to comprehend for non-field related readers. In essence, more than 40,000 patients around the world have undergone DBS. Most have experienced remarkable improvement, and news of successes has been reported widely. Yet between brain and device are ambushes and challenges less often captured, and they are crucial to a clearer understanding of what doctors and scientist mean by breakthrough. I highly recommend this book to those who are interested in brain disorder and new treatment methods.
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