Indian Write- Ups

The use of electricity to treat diseases is among the earliest recorded medical procedures. Physicians in ancient Egypt used jolts from an electric catfish native to the Nile River, to reduce the pain of arthritis. In one scan through museums devoted to the history of medicine are full of “shocking” hardware, ranging from static electric generators and simple batteries to the forerunner of modern electroshock equipment. Today, thousands of people who would suffer from otherwise crippling pain are able to lead normal lives because of implants that would deliver electric stimulation to the nerves of the spinal cord.

Epilepsy that afflicts an estimated 50 million people worldwide in characterized by repeated disturbances of the electrical activity within the brain, commonly called seizures.

According to Dr. Schulder, a neurosurgeon at University Hospital, New Jersey, almost every movement disorder can be treated with deep brain stem stimulation, with applications in epilepsy and chronic pain.

Deep Brain Stimulation (DBS)

This is a medical therapy in which an implanted device delivers electrical stimulation to regions deep in the brain. The uses of DBS to treat epilepsy is in the early stages of research.

The device consists of three major components.

• A lead composed at a thin wire with electrode contacts on it, implanted surgically into the brain.
• A pacemaker like generator, which is placed under the skin in the chest region and is programmed to deliver electrical stimulation to the brain lead
• A connecting cable, tunneled under the scalp and neck, which links the brain lead to the generator.

Target areas for brain stimulation

These include the cerebellum, caudate, thalamus maxillary nuclei, anterior nucleus of the thalamus and sub-thalamic nucleus.

Treating Epilepsy

During seizure, the brain’s normal electrical activity becomes overactive. Evidence from animal studies shows that the delivery of electrical stimulation to certain brain targets can sometimes stop this electrical hyperactivity, ending seizure symptoms that are underway. Theories abound as to how DBS works and one theory is that electrical stimulation blocks areas of the brain that can contribute to the generation or spread of seizure activity.

Research

Studies are ongoing addressing the role of DBS in epilepsy. The areas pursued are brain targets for DBS in epilepsy, effectiveness of DBS in epilepsy, the ability of DBS to start or abort epilepsy, stimulation parameters for epilepsy, timing of DBS and co-medication policies.

Reference

• Fisher RS, et al. Placebo controlled pilot study of the centromedian thalamic stimulation in the treatment of intractable seizure, Epilepsia 1992; 33; 841-51.
• Mirsk MA, et al. Anticonvulsant effect of electrical stimulation in the rat. Epilepsy Research 28; 89-100, 1997.
• Starr, et al. Deep brain stimulation for movement disorders. Neurosurgery clinics of North America 9:381-402, 1998.