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Can Integrating TMS and DBS Improve Outcomes for Treating Brain Conditions?

By 
Nikki Novick

Brain stimulation therapies can play a role in treating certain mental disorders.

A study shows that about 1.2 million adults in the United States are diagnosed annually with a chronic brain disease or disorder. Brain disorders include any disabilities or conditions that affect your brain. As your brain is your body’s control center, when damaged, it can negatively affect a lot of things, such as your sensation, memory and even your personality. 


What is Brain Stimulation Therapy?

Brain stimulation therapies are potential treatments used to relieve symptoms of certain mental or neuropsychiatric disorders when medication and therapy are unsuccessful in doing so. Brain stimulation therapies involve activating or inhibiting the brain directly with electricity, magnets or implants. The electricity can be induced to the patient directly by electrodes being implanted in the brain, or noninvasively by electrodes being placed on the scalp, or by using magnetic fields and applying them to the head. 


Although brain stimulation therapies are used much less in comparison to medication, they have been quite successful in improving treatment outcomes for patients suffering from mental disorders that do not respond to other treatments. Two specific brain stimulation therapies, transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) have shown extremely successful treatment outcomes in patients suffering from certain mental conditions. 



What is Transcranial Magnetic Stimulation (TMS)?



Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain in order to improve symptoms of mental disorders like depression. 

Because this treatment for depression often involves delivering repetitive magnetic pulses, it's called repetitive TMS (rTMS). In 2008, rTMS was approved for use by the FDA (Food and Drug Administration)  as a treatment for major depression. Repetitive transcranial magnetic stimulation (rTMS) uses an electromagnetic coil to activate the brain by placing it against the scalp. 

A patient undergoing transcranial magnetic stimulation (TMS). The electromagnet is shown placed next to patients forehead as it painlessly delivers a magnetic pulse, stimulating specific regions of the brain. Image courtesy of twitter.com. 
A patient undergoing transcranial magnetic stimulation (TMS). The electromagnet is shown placed next to patients forehead as it painlessly delivers a magnetic pulse, stimulating specific regions of the brain. Image courtesy of twitter.com

The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the regions of the brain that show decreased activity in depression, easing symptoms and improving overall mood.

What is Deep Brain Stimulation (DBS)?

Deep brain stimulation (DBS) is a neurosurgical procedure that involves implanting electrodes in certain areas of the brain, producing electrical stimulation in order to try to regulate abnormal impulses. 


This neurosurgical procedure involves the placement of a medical device called a neurostimulator, which sends electrical impulses through electrodes to specific areas of the brain. 


This procedure is used for the treatment of movement disorders such as: 

  • Epilepsy
  • Parkinson’s disease
  • Essential tremor
  • Obsessive-compulsive disorder (OCD)
  • Dystonia


Deep brain stimulation is also being studied as a potential treatment for the following neuropsychiatric conditions:

  • Huntington’s disease and chorea
  • Tourette syndrome
  • Cluster headaches
  • Chronic pain


Deep brain stimulation may be used to treat people suffering from either movement disorders or neuropsychiatric conditions once symptoms can no longer be controlled with medications or if their side effects begin to interfere with a person’s daily activities. 


Even though deep brain stimulation is usually considered to be low risk, any type of surgery has the risk of complications. Also, the brain stimulation itself can cause side effects by the electrical impulses affecting certain cells and chemicals within the brain.



Prior to surgery, medical tests including brain-imaging studies, also known as an MRI, are needed to help determine the areas of your brain for optimal placement of the electrodes. These studies will also help to determine that deep brain stimulation is the right option for the patient. 


Deep brain stimulation involves the neurosurgeon to create small holes in the skull to implant the electrodes into the brain tissue in the optimal placement. After creating the small holes in certain areas of the skull, neurosurgeons implant one or more wires, known as “leads” inside the brain tissue. 



Deep brain stimulation directly changes brain activity in a controlled manner. Picture shows the electrode implantation for deep brain stimulation. Image courtesy of nejm.org. 
Deep brain stimulation directly changes brain activity in a controlled manner. Picture shows the electrode implantation for deep brain stimulation. Image courtesy of nejm.org

The leads are then connected with an insulated wire extension to a tiny neurostimulator, the device that contains batteries that is implanted under the skin in the chest. The implanted neurostimulator creates continuous pulses of electric current to pass through the leads and into the brain. 


Both the neurologist and the surgeon carefully monitor your brain to help ensure correct electrode placement during surgery.


After both the lead(s) and neurostimulator are in place, the patient will return to the doctor to have the neurostimulator programmed for optimal electrical stimulation. Generally, the programming begins a few weeks following the procedure. 


Keep in mind that programming takes time and might even require multiple doctors appointments for adjusting the neurostimulator settings. Following the procedure, the doctor(s) will address the correct dosages of medications to take so that the medication works effectively with the electrical stimulation in order to symptoms. 


Brain stimulation therapies are potential treatments used to relieve symptoms of certain mental disorders when medication and therapy remain unsuccessful. Two specific brain stimulation therapies, transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) have shown extremely successful treatment outcomes in patients suffering from certain mental disorders. 

​​Neurosurgeon Ashesh Mehta, MD, was the first neurosurgeon to successfully treat epilepsy with the FDA-approved deep brain stimulation procedure in New York. Image courtesy of northwell.edu.  
​​Neurosurgeon Ashesh Mehta, MD, was the first neurosurgeon to successfully treat epilepsy with the FDA-approved deep brain stimulation procedure in New York. Image courtesy of northwell.edu.  

Research shows that by integrating brain lesion datasets with the data on how the two treatments, transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) both influence neuropsychiatric disorders, allowed researchers to develop a new brain mapping approach that may help the treatment of a variety of neuropsychiatric conditions as well as identifying promising stimulation sites to target therapeutically. 


This approach was developed by using data on depression and Parkinson’s disease, both of which are commonly treated with transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS). 


Due to the study of data on the outcomes of both the transcranial magnetic stimulation (TMS) procedure and the deep brain stimulation procedure (DBS), researchers have been able to make significant advancements in correlating aberrations in specific brain circuits with neuropsychiatric conditions. 


 


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