Deep Brain Stimulation (DBS) Research at the University of Florida is aimed at perfecting current procedures and developing new uses for the technology.
Many human central nervous system diseases are associated with abnormal patterns of physiologic activity in brain circuitry. One group of diseases involves abnormalities in a family of 5 parallel circuits which control both motor and non-motor functions. These circuits belong to a group of structures called the basal ganglia. Based on a plethora of animal and human research, we have learned that rates and patterns of electrophysiological activity are abnormal in many of these basal ganglia circuits. We can change the rates and patterns of activity by implanting brain stimulators into one of many targets including the thalamus, subthalamic nucleus, globus pallidus, internal capsule, nucleus accumbens, and other regions.
We can place these deep brain stimulation devices in an operating room setting utilizing advanced brain imaging, stereotactic targeting, microelectrode recording, and macrostimulation. The placement will often need to be within a millimeter or less of the optimal target to improve symptoms and avoid side effects.
By applying electrical stimulation in these regions we can change the abnormal brain conversations and effectively treat many diseases including Parkinson’s, tremor, dystonia, and obsessive compulsive disorder. After placement the electrodes remain implanted and adjustments can be made to stimulation settings (pulse width, frequency, amplitude) for changes in symptoms over time.
The initial focus of brain stimulation was on motor improvements and motor circuits, however depending on the location of a deep brain stimulation electrode, cognitive and limbic circuitry can also be affected. Positive and negative changes in mood and affect can be precipitated, especially by misplaced electrodes. Deep brain stimulation can lead to changes such as laughing, crying, anxiety, and fear (as well as a host of other effects). We are challenged to understand both the motor and non-motor effects of brain stimulation, and to design electrodes
and devices to improve bothersome symptoms and to avoid side effects.
We are currently challenged to improve
- Patient selection
- Implantation techniques
- Speed and accuracy of intra-operative procedures
- Battery life and battery recharging
- Lead design
- Lead programming
- Develop remote programming and cycling strategies to improve device performance
We are also challenged to adapt and apply this technology to help patients with other diseases or problems.