Readers Review: Deep Brain Stimulation


Deep Brain Stimulation CoverWe invited readers to pick up an early copy of our March book Deep Brain Stimulation: A New Treatment Shows Promise in the Most Difficult Cases, by Jamie Talan, and tell us what they thought. Here are a few reviews:

 

A fascinating journey

The book of Jamie Talan - Deep Brain Stimulation: A New Treatment Shows Promise in the Most Difficult Cases - takes us on a fascinating journey, one of the most incredible science odysseys of our time. This excellent and comprehensive book covers the rapidly growing use of deep brain stimulation (DBS), and will be a valuable resource for clinicians involved in the use of deep brain stimulation as well as for patients seeking information.

Along the chapters, it becomes clear that the DBS technique is not only clinically useful, but that it can also provide new insights into fundamental brain functions. At the end of the book, the author emphasizes that if deep brain stimulation has become the neurosurgical procedure of choice for patients with disabling movement disorders and is currently also being explored for patients with a variety of severe neuropsychiatric disorders, we must remember that DBS is a treatment and not a cure.

This book offers hope and help for desperate patients with disabling Parkinson’s disease, tremor and other movement disorders. It is definitely worth to read.

Sophie ter Cock, PhD.
Netherlands
 

More on consciousness than pain

Jamie Talan has a flair for writing about a very complicated and technical surgical procedure. Her style is understandable and comprehensive for lay persons.

Ms. Talan's chronological timetable is the core of this book. She is a master at weaving the history of Parkinson's with principally European researchers' discovery of electrodes as the catalyst for silencing the symptoms of tremor.

The honesty of surgical failures is comforting. The surgical accidents paved the way for successful advancements. Movement disorders patient stories of success and failures stimulated hope for mental health patients and other maladies, like pain.

However, the author leaves the reader with an unfinished story about the ballerina on page 118. The reader is left not knowing about "the work in progress." Also, the pages on pain and consciousness are unbalanced. There are double the pages on consciousness versus pain, which the reasonable lay person can identify more with.

But, the layperson can appreciate the author's warning about "selling DBS to both patients and neurosurgeons. It's important for the uneducated patient to know that there are neurosurgeons that do not have the required experience to perform DBS. There is an organization currently embedded with Medtronic, "selling DBS" through patient seminars. 

There is one personal disappointment for me reviewing this book. I thought there would be more content about essential tremor, as my understanding is that there are more than ten million people with this movement disorder. Yet, the author only mentions essential tremor sparingly in the Prologue.

It's hard for me to believe most of the DBS patients are Parkinson's patients, as the ratio of essential tremor patients far exceeds the number of patients diagnosed with Parkinson's.

Thank you for giving me the opportunity to read this book.

Beverly Parenti
Hayward, CA
 

A thorough historical look

I was very impressed with Deep Brain Stimulation by Jamie Talan. It was a thorough historical look at brain stimulation for brain disorders. But it also gave an incredible and easily understood explanation of the treatments that are currently available and the pitfalls and positive outcomes for different disease processes which is the most valuable aspect of the book. I found it a great explanation as a doctor to cover this often confusing topic but also I have already recommended it for a patient as I think it gives an unbiased view so patients can make educated decisions on their own treatments which is vital for something as complex as Parkinson's or other movement disorders. Thank you! Michelle

Michelle Hemingway, MD
Lennox, MA
www.mhemingwaymd.com

Not for clinicians, but a book about people

A book on Deep Brain Stimulation (DBS) is a much-needed resource, as there is a paucity of written material on neuromodulation. Deep Brain Stimulation by Jamie Talan is not a book to inform clinical decision or education on novel treatments, however; it is a book that illuminates the players, neurosurgeons, and psychiatrists involved in breaking ground in this field.  In 1997, the FDA approved DBS for Parkinson’s disease, and shortly thereafter came experimentation with DBS for psychiatric purposes.

Talan devotes a whole chapter to Irving S. Cooper, an early maverick.  She introduces Alim-Louis Benabid as the “father of DBS.”  We also learn of Joseph Fin’s contribution regarding ethics, as well as Wilder Penfield’s cautions as highlighted in his book No Man Alone. Jean Talaraich made major contributions to brain mapping.

Deep Brain Stimulation is a “technique involving stimulating the brain with electric current pulses of low intensity using depth electrodes implanted through the skull.”  Given the recent renegade atrocities of Freeman lobotomies of the 1950s, this field needs to proceed with transparency and caution on the part of the surgeons and providers offering these novel treatments.  The DBS device is similar to a pacemaker, with leads entered into the brain through burr holes and a battery pack implanted in the chest.

I am biased in favor of the healing offered by these novel treatments, since my husband received Gamma Knife capsulotomy and subsequently was able to "join the world again.”  Gamma Knife is another novel treatment in which Cobalt 60 beams are focused on an intended target to create lesions in the brain.  This procedure is ablative (reversible) as opposed to non-ablative DBS. Talan also references Lars Leksell, who developed the Gamma Knife at Karolinksa Institute in Sweden. The Gamma Knife is also non-invasive where DBS is not.

The debilitating nature and public health burden of chronic psychiatric illnesses and the limited response to medications and current treatments makes these novel treatments attractive.  However, costs and benefits must be carefully weighted and established protocols adhered to.  The most successful treatment centers offer collaborative care and intense long-term follow-up.  Collaboration must include psychiatrists willing to refer and closely follow patients for years following surgery, along with neurosurgeons and ethicists; often these committees also include community members and laypersons.

Some of the controversy comes with a mandate of informed consent, which could be lacking or questionable in persons experiencing severe mental illness. Hence the burden is placed upon the doctors involved in promoting these types of treatments.  If this field advances and is approached critically with consideration of ethics, as procedures are perfected it could give new hope for conditions where options are limited.

Mim Schwartz, Board Member
National Alliance for the Mentally Ill (NAMI)
 
A Book for patients, parents and partners
 
Deep Brain Stimulation is an exploration and history of neurosurgery.  One can almost create a motor homenculus quilt as Jamie Talan patches together the trials and errors of scientific probing.  Patients, parents, and partners will appreciate Talan's range of degrees of severity from OCD to Parkinson's to depression to epilepsy and more.  When is the right time to take control of a disease?  Where is that fine line between functioning depression and a need to seek advanced therapies or surgery? Deep Brain Stimulation is one of the tools to help make an informed decision

Sue Willows-Raznikov
Stanford, CA 

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