Pacemaker for the Brain

brain

Pacemaker technology is an offshoot of the space program, and there are many new offshoots of the pacemaker. One exciting new application for the basic implantable pulse generator is the "brain pacemaker."

Physicians in Heidelberg, Germany, have been studying severe clinical depression and believe that it is related to the habenula, a tiny nerve network within the brain. It appears that when the habenula becomes overactive, the person gets depressed; likewise, when the habenula calms down, the depression lifts.

Credit for this theory goes to Dr. Alexander Sartorius who works at the Brookhaven National Laboratories in New York. The next challenge was how to take that insight and translate it into a medical therapy.

A pacemaker-like device was developed. The pulse generator was implanted in the chest, like a regular cardiac pacemaker, and leads plugged into the pulse generator. But these leads did not go to the heart. Instead, the leads went upward into the brain so that the electrodes could stimulate brain tissue.

Dr. Karl Kiening of Heidelberg University Hospital performed the delicate surgery in the first-ever implant in January 2010 to treat depression. Such "brain pacemakers" already exist to treat Parkinson's Disease and other disorders.

The electrodes send out low-voltage pulses to stimulate certain areas of the brain, much as a heart pacemaker sends out low-voltage pulses to stimulate cardiac tissue.

The patient who underwent the first implant for depression had good results. In fact, when her pacemaker was turned off because she had to undergo a different, unrelated medical procedure, her depression returned but was banished as soon as her brain pacemaker was reactivated.

The medical name for this technique is "deep brain stimulation." While results are good and the technology for this kind of device exists, the biggest obstacle is that the surgery requires pinpoint accuracy to get the electrodes in the proper position.. Furthermore, the habenula are located in the center of the brain, making surgical access particular challenging.

While it may seem counterintuitive, stimulating the habenula appears to have a calming effect on these little nerves.

 

 

 

 

 

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From Ontario, Canada's paper Globe & Mail, we found out about a novel use for pacemakers to treat a very rare condition that impedes breathing. Congenital hypoventilation or alveolar hypoventilation occurs when a person is born without the body's natural impulse to draw breath.
 
A person with this condition can simply stop breathing and may be unaware of his or her body's urgent demand for oxygen. People with this condition are sometimes tethered to ventilation machines to be sure that they keep breathing. While this can help with the immediate problem (impaired ability to breathe), people on these machines long term are at high risk for pneumonia and other respiratory infections. Furthermore, being hooked up on a machine all of the time definitely decreases quality of life.
 
Pacemakers have long been known to have a potential side effect: they can sometimes stimulate the phrenic nerve. The phrenic nerve is located near the heart and lungs. Pacemakers can also stimulate the diaphragm, a muscle below the lungs that helps the lungs expand and contract. If you have ever suffered from a bad case of the hiccups, you know how powerful the diaphragm can be. Hiccups occur when the diaphragm gets out of whack with the body's natural breathing cycles.
 
Late December 2009, doctors in Canada implanted a pacemaker in the diaphragm of a 50-year-old woman who had the rare breathing disorder (hypoventilation). It is the same kind of pacemaker that one would use to stimulate the heart, only in this case it stimulate the diaphragm. That, in turn, is thought to help stimulate breathing.
 
Similar procedures have been performed on people with spinal cord injuries who were having trouble breathing. Doctors speculate that there may be more and more uses for the "diaphragm pacemaker," including to treat patients with amyotrophic lateral sclerosis or ALS (Lou Gehrig's disease).
 


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