Talk:Deep brain stimulation/Archive 1

Archive 1

Potential complications & side-effects

I think this section focuses to heavily on the more serious and rare complications of DBS, as opposed to overall complications and side effects. Also, the references cited refer to neuropsychological/neuropsychiatric complications in Parkinson's cases only. GridEpsilon 05:52, 21 November 2006 (UTC)

I don't know who inserted it, and I certainly support removal of any unreferenced text (unless it can be cited), but referenced text should not be removed, and all side effect discussions with all medical situations involve mostly rare side effects - that discussion should not be necessarily excluded, although adding a broader discussion of overall complications would be helpful. It is a dangerous procedure, and that shouldn't be whitewashed. Sandy (Talk) 14:19, 21 November 2006 (UTC)

I support the discussion of all potential complications and no way intend to diminish the significance of the procedure (I've had it done), but I believe the editor's view was too narrowly focused (undue weight) on the neuropsychiatric side effects, while infection and bleeding received a mere mention. There is also no mention of common stimulation-related side effects, and most of the section does not cite references. I think this section should be moved to the Talk page or a POV check added until it can be updated. Thoughts? (see references here and here). GridEpsilon 22:04, 21 November 2006 (UTC)

Tipping Point and Cushion

What exactly do the terms tipping point and cushion mean in this article? The links, especially to cushion do not make a not of sense.--Eraticus 07:45, 23 November 2006 (UTC)

No idea who added that text, but I deleted it anyway - Wikipedia is an ecyclopedia, not a how-to manual; giving that level of surgical detail isn't appropriate, particularly when it's not referenced. Sandy (Talk) 08:08, 23 November 2006 (UTC)

Merge proposal

I disagree, and don't see the reason for the proposed merger: convince me why the stimulator shouldn't have its own article? Sandy (Talk) 00:20, 20 November 2006 (UTC)

Although it is not referred to in the thalamic stimulator article, the thalamic stimulator in the article's context *is* deep brain stimulation, as noted here in the reference source.

"The Food and Drug Administration has approved a brain implant device to help control tremors in people with essential tremor or Parkinson's disease. The device, a deep brain stimulator made by Medtronics Corp. of Minneapolis, Minn." GridEpsilon 01:09, 20 November 2006 (UTC)

Yet, it's not even mentioned in this (the DBS) article, which is a problem. I may be mistaken, but I believe the concern as to whether it should have its own article is whether it would be a frequent search term for people looking for information about the thalamic stimulator: since it could be a valid search term, I'm not clear why it shouldn't have its own article, and why it isn't mentioned in this article ?? Sandy (Talk) 01:41, 20 November 2006 (UTC)

I think a stimulator should have its own page, if it contained accurate information. The main problem with this article is that it indicates that a Thalamic stimulator suppresses tremors caused by Parkinson's Disease or essential tremor. However, treatment for these tremors (which is what Deep brain stimulation really is), is performed by stimulating primarily the Subthalamic nucleus or the Globus Pallidus, which are nuclei of the basal ganglia, not the Thalamus. Thus, the definition in this article is incorrect. Thalamic stimulator could be mentioned in the DBS article, but it needs to be corrected first. Lujanjl 03:23, 20 November 2006 (UTC)

The thalamic stimulator article is correct. Essential tremor and "Parkinsonian" tremor is treated in the thalamus (as seen here). The DBS article needs to be corrected, though. There are three seperate DBS treatments for different disorders in either the thalamus, globus pallidus or subthalamic nucleus (all manufactured by Medtronic under the brand name Activa Therapy). GridEpsilon 04:44, 20 November 2006 (UTC)

I apologize. I misread the Thalamic stimulator article. I thought it claimed thalamic stimulation was the only treatment for PD's tremor. [1] Lujanjl

Yes, whether the information is correct should be a separate issue from whether articles should be merged: merging (as I understand it) would be if the search terms weren't important enough to warrant individual articles that would be valid search terms, and on that basic, I think both articles should be corrected and wikilinked to each other, rather than merged. I'm only responsible for the Tourette section - I can't help with the rest, as I'm not a physician. Sandy (Talk) 03:29, 20 November 2006 (UTC)

Although both articles do address the same device, and the deep brain stimulation article needs to be expanded and include reference to the Activa name (see my reply above), the underlying procedure is widely refered to as deep brain stimulation in medical literature. I think it would be better served for all aspects of DBS components to be covered under this article. We could always leave a redirect for those searching under different names rather than having multiple articles spanning the same topic. GridEpsilon 04:44, 20 November 2006 (UTC)

Thalamic stimulator gets 2,000 Google hits; Deep brain stimulation gets 486,000. I can be convinced, based on the low google hits, they should be merged if you all tell me there is nothing to be said about thalamic stimulator apart from what is said about DBS. It seems to me (as a layperson) that one is a procedure, and the other is an object - help me out here. I still can't see why an FDA-approved device shouldn't have its own article. Why doesn't the thalamic article just say, "A thalamic stimulator is a relatively new medical device used in deep brain stimulation," while this article should mention the device with a wiki link back to the device? Sandy (Talk) 04:55, 20 November 2006 (UTC)

You are correct, that one is a procedure, the other a device. However, the thalamic article implies a dedicated device in relation to thalamic stimulation, whereas it is not; the neurostimulator/IPG is simply the power source which generates the electrical pulses to the lead/electrodes (in either the STN, GPi or thalamus) as described in the DBS article. Although, a new article could be done on the "neurostimulator" and linked back to DBS, which is probably a better idea. But the thalamic article in it's current form (referring to other components and surgical procedure) I think is better covered under DBS. GridEpsilon 05:21, 20 November 2006 (UTC)

I must be thick: if the thalamic article is wrong, why not just fix it, rather than merging the article? It's still an FDA-approved device (hence, has some notability for an article, I presume? or am I wrong?) If it's a notable device, then its article should be corrected. Sandy (Talk) 05:25, 20 November 2006 (UTC)

I agree with GridEpsilon in that a neurostimulator article should be used. Thalamic stimulator is a type of neurostimulator/IPG. Thalamic stimulator refers only to the use of an implanted stimulator for a specific anatomical landmark. FYI, Medtronic's deep brain stimulators were derived from cardiac pacemakers. There are many disciplines (e.g., Functional electrical stimulation) that use similar stimulator technology for different applications: motor control after Spinal cord injury, bowel and bladder control, pressure sore prevention, etc. It is just not feasible to have a separate article for each one, even though many of them are FDA approved devices. Lujanjl 19:07, 20 November 2006 (UTC)

That sounds good: thalamic stimulator could be redirected to neurostimulator and discussed there as one type of neurostimulator, and neurostimulator should be wikilinked in DBS - does that work for everyone? Sandy (Talk) 19:34, 20 November 2006 (UTC)

That's sounds fine, just one item of note - as far as DBS is concerned and I believe neurostimulators in general), the same stimulators are used (there are several models) regardless of which brain structure is being targeted, it's just a matter of which model is used for a particular application (bilateral vs. unilateral implant, battery life needs, etc.), they really aren't different "types" of stimulators. I've also removed the merge proposal tag. GridEpsilon 22:10, 20 November 2006 (UTC)

Don't forget about NeuroPace. Medtronic isn't the only manufacturer of brain stimulators. MoodyGroove 02:00, 26 January 2007 (UTC)MoodyGroove

Neither of them belong in the article (commercial links): I wish someone would provide medical references for the statements currently ref'd to Medtronic ... soon. SandyGeorgia (Talk) 02:07, 26 January 2007 (UTC) Did it myself. SandyGeorgia (Talk) 02:16, 26 January 2007 (UTC)

Electroconvulsive therapy (ECT) and Deep brain stimulation (DBS)

I wonder if Electroconvulsive therapy (ECT) should be linked to Deep brain stimulation (DBS) as both are used for the similar reasons (mental health) and involve the use of electricity. --Antidote 13:48, 9 April 2010 (UTC)--Antidote 13:52, 9 April 2010 (UTC)

Interesting point. I added it as a "see also". They are substantially different though, so I don't think it's worth detailed description in this article. For instance invasive vs noninvasive, surgical vs psychiatric, precise MRI guided vs blunt instrument, plus the most common indications are quite different. --PaulWicks (talk) 20:07, 9 April 2010 (UTC)

References

Someone should add comments on the mechanism of DBS in parkinsonian STN-stimulation that has been elucidated by the Deisseroth team at Stanford U: "Optical deconstruction of parkinsonian neuronal circuitry" —Preceding unsigned comment added by 130.235.170.108 (talk) 16:35, 24 August 2010 (UTC) Since this article is finally getting editor attention, it needs to be correctly referenced. There are broad patches of text that don't have a reference or carry inline citations. (I wrote only the TS section - it's cited.)

Clinical depression references

I just extended the references in the Clinical depression section, as the reference given for the first paragraph appears to apply to the second two paragraphs. Someone who has the study should verify that the reference applies to and substantiates the entire section:

Researchers reported in 2005 that electrical stimulation of a small area of the frontal cortex brought about a "striking and sustained remission" in four out of six patients suffering from clinical depression, whose symptoms had previously been resistant to medication, psychotherapy and electroconvulsive therapy.

The researchers reported that, using brain imaging, they noticed that activity in the subgenual cingulate region (SCR or Brodmann area 25) — the lowest part of a band of tissue that runs along the midline of the brain — seemed to correlate with symptoms of sadness and depression. They implanted electrodes into six patients while they were locally anesthetised, but alert. While the current was switched on, four of the patients reported feeling a black cloud lifting, and became more alert and interested in their environments. The changes reversed when the current was switched off. For dystonia and symptoms associated with Parkinson's disease (rigidity, bradykinesia/akinesia and tremor), the lead may be placed in either the globus pallidus or subthalamic nucleus.

References

Also, it's not clear why this section is separate from Procedure. Sandy (Talk) 09:16, 23 November 2006 (UTC)

Memory enhancement references

• Annals of Neurology, Volume 63 Issue 1, pp 119-123, January 2008 [2] doi:10.1002/ana.21295
• News report in the Independent (UK) Scientists discover way to reverse loss of memory —Preceding unsigned comment added by Vendeka (talk • contribs) 09:43, 30 January 2008 (UTC)
• The press release "Fluke discovery suggests deep brain stimulation may help mitigate memory loss" 2008-01-30
• local followup story 2008-01-30 LeadSongDog (talk) 16:12, 30 January 2008 (UTC)

potential resource

"Deep-Brain Stimulation Found to Fix Depression Long-Term; The first placebo-controlled trial of implanted electrodes is positive, but recovery is usually slow and procedures are being fine-tuned" by Alison Abbott Scientific American January 3, 2012 See Depression 99.181.147.68 (talk) 05:22, 4 January 2012 (UTC)

That is 1) a laypress report summarizing 2) a primary study of 3) a small sample of only 12 patients (all three contrary to how Wikipedia's medical articles are optimally sourced). Please see WP:MEDRS and WP:NOTNEWS; encyclopedic medical entries rely mostly on secondary reviews of primary studies, and avoid reporting from the news or media. If these results are covered in a secondary medical journal review of the primary study, they would make for a good inclusion here. In the meantime, there are numerous secondary reviews available on PubMed, and even several that are freely available that can be tapped for writing this article according to WP:MEDMOS and WP:MEDRS. SandyGeorgia (Talk) 16:16, 4 January 2012 (UTC)

Review

... in J Clin Invest - doi:10.1172/JCI68341 . These are always of very high quality. JFW | T@lk 20:44, 3 November 2013 (UTC)

Multiple Sclerosis

See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1757382/pdf/v074p01392.pdf Tremor symptoms from MS seem to be treated by DBS, yet ms/multiple sclerosis does not seem to be mentioned in the article. It seems to me as a layperson that making a specific reference to Multiple Sclerosis (MS) in the article would assist those looking for information re treatment of tremors in MS. 60.225.12.187 (talk) 08:08, 10 June 2014 (UTC)

Major study of deep brain stimulation fails, is shut down by FDA

Deep_brain_stimulation#Major_depression
Major study of deep brain stimulation for treatment-resistant depression fails, is shut down by FDA

http://neurocritic.blogspot.com/2014/01/broaden-trial-of-dbs-for-treatment.html

Official website: The BROADEN (BROdmann Area 25 DEep brain Neuromodulation) Study http://www.sjm.com/broaden 108.27.38.227 (talk) 14:08, 18 February 2015 (UTC)

Blogs are not reliable sources. The source appears to be Neurotechreports, which may be reliable, but I am unsure this coverage warrants mention in the article. That is a December 2013 article apparently, that hasn't received much coverage in the year since. Meanwhile, there are numerous secondary reviews that cover depression and DBS, and I have found no mention of this FDA issue. If you have a secondary or WP:MEDRS-compliant source that covers the issue, pls provide it. SandyGeorgia (Talk) 14:28, 18 February 2015 (UTC)

The failure of the trial is mentioned in a number of MEDRS-compatible sources, including PMID 24867326. The headline wording here makes this seem scandalous, but all it really means is that the treatment didn't show preliminary evidence of effectiveness in as high a fraction of the population as FDA standards require. Looie496 (talk) 16:24, 18 February 2015 (UTC)

Apparently now two placebo-controlled trials have given negative results for DBS (http://blogs.scientificamerican.com/cross-check/much-touted-deep-brain-stimulation-treatment-for-depression-fails-another-trial/). It looks like the article needs a bit of a rewrite. --sciencewatcher (talk) 17:42, 25 October 2015 (UTC)

I don't consider John Horgan a very reliable source, but PMID 26246408 and PMID 26276049 are good MEDRS-level recent reviews that could be used for a rewrite. Looie496 (talk) 14:16, 26 October 2015 (UTC)

No, of course it isn't a reliable source, and I wasn't suggesting it was. I was merely assuming Sciam wasn't outright lying, and that someone should check for a good review based on the studies. --sciencewatcher (talk) 14:27, 26 October 2015 (UTC)

Do these images bring value?

The two images here were added by User:Andreashorn in these diffs. They added similar issues, with similar citations to other articles, per their contribs.

• 
  Reconstruction of DBS electrodes. Shown are the subthalamic nucleus (orange), red nucleus (green), the substantia nigra (yellow), the internal (cyan) and external pallidum (blue) and the striatum (red). A volume of tissue activated (VTA) is modeled around the electrodes. Structural fibertracts traversing through this volume are visualized with color-coded fibers and cortical regions that they terminate in are visualized with translucent colors.
• 
  Two deep brain stimulation electrodes with target subthalamic nucleus for treatment of Parkinson's Disease are visualized. An electric field with amplitude of 3V is modeled for monopolar stimulation on the second lowermost contact, bilaterally. The E-field calculated to model the voltage distribution is visualized by white arrows and was modeled using the finite element method in Lead-DBS software

Do folks here see these images as adding value? Jytdog (talk) 17:11, 13 January 2017 (UTC)

• Yes, especially for the second image, which shows the device. (Patient POV: "They're going to stick what in my head?" Student POV: "That's kind of far down in there. No wonder they call it 'deep' brain.") The captions could use a bit of trimming, though. (It'd be nice if the second one didn't use glove-blue and operating-room-green for the simulated electrical fields; at a glance, it really looks like someone is holding them in gloved hands.) WhatamIdoing (talk) 17:56, 13 January 2017 (UTC)

the second image does seem the better of the two(as WAID indicated the caption could use trimming)--Ozzie10aaaa (talk) 10:47, 14 January 2017 (UTC)

• I think they add value, but a related question is whether they're really this wide? Carl Fredrik 💌 📧 10:48, 15 January 2017 (UTC)
• Hi – thanks for your input. The first image shows connectivity from the electrode to the rest of the brain which now is increasingly being done in connectomic surgery. Second shows details of the concept of "volume of activated tissue" (red blob) which models the area really being stimulated by the electrode, i.e. the area in which one hypothesizes action potentials are being fired due to the stimulation. Personally, I honestly don't care if the images are used. Am new to wikipedia editing and thought that us scientists should also see it as part of our job to share some insight of what we are studying with open/common sources if could be interesting for the general public. Was a bit surprised to see they were deleted although I can now understand that they seem as "primary" material to you (https://en.wikipedia.org/wiki/Wikipedia:No_original_research#Primary.2C_secondary_and_tertiary_sources). — Preceding unsigned comment added by Andreashorn (talk • contribs) 14:58, 18 January 2017 (UTC)

• my primary concern was that these images/caption/citation appear to be WP:PROMO for the software with which they were made and the paper in which the software was published. In cases like this it is best to post on the talk page and get other people's input about whether and how the images themselves add value to the WP content. Jytdog (talk) 19:47, 18 January 2017 (UTC)
• makes sense and I can totally understand that. You decide what to do with them. Best — Preceding unsigned comment added by Andreashorn (talk • contribs) 21:37, 20 January 2017 (UTC)

Dr Heath

My entry of Dr Heath in "see other" was removed when he has articles such as http://www.ncbi.nlm.nih.gov/pubmed/13931099, and many others published.--Mark v1.0 (talk) 22:59, 19 January 2016 (UTC)

As I wrote in my edit note, the problem was the unsourced (and very big) claim that he was "the first to experiment on the deep brain in humans. ". Please don't add content to WP without a source and if you make a very strong statement like that please provide a very strong source to support it. Thanks. Jytdog (talk) 23:02, 19 January 2016 (UTC)

It is not unsourced. From the National Center for Biotechnology Information , 1955 Title "Stimulation of the amygdaloid nucleus in a schizophrenic patient." http://www.ncbi.nlm.nih.gov/pubmed/14361778 is another source article. In what way is this unsourced?--Mark v1.0 (talk) 23:10, 19 January 2016 (UTC)

You did not provide a source for the claim that he was "the first to experiment on the deep brain in humans. " Not the first time you added it nor the second nor the third; it was unsourced. The reference you now provide from 1955 (which I have read) does not claim to be the first DBS experiment in humans (indeed it has footnotes to papers at least two years earlier describing DBS in people), and even if it did make that claim, we need a secondary source (a very strong one) for that very strong very claim. Jytdog (talk) 23:20, 19 January 2016 (UTC)

With an edit dispute we are supposed to discuss it on the talk page and I made the entry here on the talk page to try to come to consensus. The medical library I used as a reference is a legitimate source in my editors point of view because it has the date and the description of the deep brain area.--Mark v1.0 (talk) 23:29, 19 January 2016 (UTC)

Yes we are talking. I think you know what sourcing means - it means an in-line citation. I don't know what you are talking about with regard to your "medical library". You need a source to cite for the claim that he was "the first to experiment on the deep brain in humans." What is it? Jytdog (talk) 23:35, 19 January 2016 (UTC)

The exact wording does not exist but I think this is a good online reference to Heath's early (1950-60's)work. http://www.medscape.com/viewarticle/726594_3 --Mark v1.0 (talk) 15:42, 26 December 2016 (UTC)

I found another medical article on the history of DBS with Dr Heath totally absent. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157831/ --Mark v1.0 (talk) 16:21, 24 May 2017 (UTC)