7 ms·

The agony and the ecstasy of deep brain stimulation surgery

159 points by masijo 5y ago

izuchukwu 5y ago
Listening to his recording of the subthalamic nucleus—as he describes it, "the sound of hundreds of thousands of your own neurons excitedly relaying the information they carry to one another fill[ing] the room"—was worth the read alone. Highly recommend reading this post. To the author: thank you for sharing, and I wish you a successful course of treatment.
- remarkEon 5y ago
  Yeah that was super interesting and when I listened to the recording the first thing I thought of was the high frequency (well, relatively speaking of course) clicking sounds dolphins and some other cetaceans make. Always wondered if there was a connection there when brain information is translated “in the raw”.
  - andy_ppp 5y ago
    Very beautiful these connections we can make, imagine if dolphins can think as one… click click click.
stretchwithme 5y ago
That's why I always go for the non-invasive brain surgery whenever the option is available.
- mazlix 5y ago
  You’re probably joking but TMS (transcranial magnetic stimulation) is a real thing. In which electromagnetic fields are used to stimulate the brain from the outside.
  - andai 5y ago
    My favorite TMS fact is that if you target a specific area of the brain, bombard it with electromagnetic stimulation (which apparently "disables" it for 20-30 minutes) you get a remarkable increase in working memory (nearly a doubling, if memory serves me).
    - qq4 5y ago
      Whoa, that sounds really interesting. Source by any chance?
Trias11 5y ago
It even hurts to read the title.
- golem14 5y ago
  Ha. There's a short story in which the narrator is invited to a dinner to eat monkey brain, but is tricked and consumed himself. Can't remember the author or name of the story (would think ea Poe or Roald Dahl). Was making a big impression on me when I first read it as a child. Anyone knows the story ?
- noisy_boy 5y ago
  I strongly recommend you never watch Red Dragon: https://www.imdb.com/title/tt0289765/ https://www.imdb.com/title/tt0289765/
carl_dr 5y ago
I didn’t see that it was stated what the surgery was for, and I am unfamiliar with deep brain stimulation. For anyone else in the same boat, for the author, it is a method of managing the symptoms of Parkinson’s disease. A fascinating read.
- insickness 5y ago
  > Normally if I had gone till noon without any medication I would have had a pronounced tremor Yeah, probably some type of Parkinson's.
- casion 5y ago
  He has another post describing that he has parkinsons: https://tmrwedition.com/2021/01/30/pros-and-cons-of-four-different-brain-surgeries-for-parkinsons-disease/ https://tmrwedition.com/2021/01/30/pros-and-cons-of-four-dif...
- DoingIsLearning 5y ago
  Small correction, DBS is not limited to just Parkinson's treatment. Although Parkinson's is the most common disease to be treated with DBS, the technique is used in a broad set of diseases/conditions where you have some form of dystonia. Source: Worked on a Neurosurgery software suite a few years back.
insickness 5y ago
> I did wonder, what would it be like if something went wrong... What would I experience? Would the world suddenly go dark? Would my conscious awareness and this chain of experience I call my self suddenly shift to something else? I think this would have been an important question to ask the surgeon prior to surgery. What if something goes wrong?
- hsbauauvhabzb 5y ago
  Probably about the equivalent of ‘undefined behaviour, in a computer program - maybe you segfault, maybe you unlock the ability to speak Spanish fluently. It all depends on the when and where.
UI_at_80x24 5y ago
I've had fully awake brain-surgery. 1990 I was under 16 years of age. I had a tumor causing epileptic seizures. I had my right-temporal lobe completely removed. I was talking to the surgeon while he worked on me. They needed to communicate to (a) make sure they didn't affect my speech center, and (b) try to manually trigger a seizure (aura) to test if they were close. I smell burnt toast Dr Penfield. [ https://www.youtube.com/watch?v=pUOG2g4hj8s https://www.youtube.com/watch?v=pUOG2g4hj8s ] The most painfull part of the procedure was getting the needles under my scalp to numb the skin (a local anesthesia) before they drilled in. The mostly used hand-tools. 2 holes were drilled (using a hand-drill). They created a large reverse question mark, going from infront of my ear (in my sideburn), up around the 'corner' of my head, and then back towards the back of my head. They used a hacksaw, and then the flap that was left over was laid back onto my head. I'll be happy to answer any questions that anybody may have.
- souldeux 5y ago
  I'm not quite sure how to phrase this, but here goes: during this procedure did you experience anything that you feel you could not have experienced absent someone physically poking your brain?
  - UI_at_80x24 5y ago
    In short, no. The operation itself lasted for over 12hrs, but I am only aware of (approximately) the first hour. So weird shit may have happened, but I have no memory of it.
    - ibizaman 5y ago
      How come you only remember the first hour?
      - UI_at_80x24 5y ago
        Mostly because I had severe head trama! =) lol At some point they put me out, so that messes with your memory too, but I think `brain surgery` is a good reason to not being able to remember. If you get into a car accident and hit your head or get a concussion you don't remember everything either.
polishdude20 5y ago
How do they put in the wires into the brain without messing up some critical parts along the way?
- pineal 5y ago
  The neurosurgeon meticulously plans the exact trajectories prior to surgery and we use a combination of software and hardware (Stealth or Brainlab) to ensure we follow the planned path. Of course, complications still occur but are fairly rare, serious or permanent ones even more so.
  - polishdude20 5y ago
    Are they actually piercing into the brain matter or are there gaps in the brain? Does the trajectory avoid actual neurons on the way?
    - pineal 5y ago
      The brain matter is indeed pierced. While “you only use 10% of your brain” is a myth, much of the brain is what we call non-eloquent, meaning it can be damaged or removed without any noticeable effects. Especially when it just means being pierced by a 2-3mm diameter lead. Are there hidden side effects that we are simply unable to recognize? Sure, but with as primitive an understanding of the brain as we currently have, we are forced to rely on a more pragmatic rather than philosophical approach.
      - polishdude20 5y ago
        Great answer! That explains so much thanks.
peanut_worm 5y ago
If I ever had something that would require this I would prefer to just be euthanized or something. I cannot even read this article without recoiling in horror. I am sure there are other people with a phobia of surgery like myself, what do they do for those people? I would definitely faint before entering the operating room.
- deltabravosam 5y ago
  I have something that does require this and I couldn't finish the article. I have no idea what I'm going to do. I'm facing potentially fatal seizures or DBS.
  - UI_at_80x24 5y ago
    I want to help. I can call you if you want, or offer my phone number for you to call me. It's not bad. You don't feel ANYTHING. If you've ever been to the dentist and had a cavity filled then that is the extent of the horror. The sounds are no worse, just different. There is no reason to suffer. Let's talk about this. (It's 23:15 Eastern, I'm going to bed soon. But we can also talk tomorrow.) Here's the number you can reach me at: 313-524-1974 My name is Matt.
    - kmote00 5y ago
      You are being a serious bro, Matt, and I commend you for it! But I would hate to see you get deluged by phone spam as a result. Please consider spelling out the letters of some of the digits in your phone number before it gets scraped.
      - EGreg 5y ago
        I always wondered, years have gone by, haven't spammers figured out how to scrape numbers from all the little tricks we have done over the years? Maybe even a reverse GPT-4 type AI?
      - UI_at_80x24 5y ago
khana 5y ago
are you kidding?
knownjorbist 5y ago
Here's an incredible video detailing a DBS procedure, treating a woman with essential tremor. It is remarkable how you can see her symptoms improve in realtime via her movements and handwriting. https://www.youtube.com/watch?v=isYY2jvd8PU https://www.youtube.com/watch?v=isYY2jvd8PU
noisy_boy 5y ago
> During which time my hair was cut, but only the parts that might get in the way of the procedure, giving me that classically handsome friar tuck look Of the many weird things I wonder about, this has been on the list for a while. Why was that totally weird haircut done? To make clergy even more irresistible than they already were? Some kind of trying to both having and eating your cake by having hair while not having hair?
- jaggirs 5y ago
  Your surgeon is not your hairdresser. He cut away what he needed to cut away, if you want to cut away more later you can do it yourself.
  - s4vo 5y ago
    The question was about the specific hairstyle ('friar tuck'-like) being done at all and not why the surgeon did it in this story.
- mbg721 5y ago
  https://en.wikipedia.org/wiki/Tonsure https://en.wikipedia.org/wiki/Tonsure It's apparently meant to evoke a crown representing the victory to be gained in the afterlife through humility on earth, in imitation of St. Peter.
lwhi 5y ago
Reading this makesme
lwhi 5y ago
Oh my - reading this makes me feel very funny. I don't think of myself as that squeamish; but anything involving sculls, brains and drilling me makes me feel instantly queasy. Amazing that this is having a positive effect, but sweet lord .. I find it difficult to even think about.
capaneus 5y ago
I was fitted with a deep brain stimulator for dystonic tremor in 2012. Their were two operation two weeks apart. In the first operation the battery was put in my chest and six screws place around my skull. Scans are done to calculate the location they want to place the electrodes relative to the screws. The second operation was done under local anaesthetic, they drilled two holes in the skull and inserted the electrodes

159 points by masijo 5y ago

Listening to his recording of the subthalamic nucleus—as he describes it, "the sound of hundreds of thousands of your own neurons excitedly relaying the information they carry to one another fill[ing] the room"—was worth the read alone. Highly recommend reading this post. To the author: thank you for sharing, and I wish you a successful course of treatment.

remarkEon 5y ago
Yeah that was super interesting and when I listened to the recording the first thing I thought of was the high frequency (well, relatively speaking of course) clicking sounds dolphins and some other cetaceans make. Always wondered if there was a connection there when brain information is translated “in the raw”.
- andy_ppp 5y ago
  Very beautiful these connections we can make, imagine if dolphins can think as one… click click click.

stretchwithme 5y ago

That's why I always go for the non-invasive brain surgery whenever the option is available.

mazlix 5y ago
You’re probably joking but TMS (transcranial magnetic stimulation) is a real thing. In which electromagnetic fields are used to stimulate the brain from the outside.
- andai 5y ago
  My favorite TMS fact is that if you target a specific area of the brain, bombard it with electromagnetic stimulation (which apparently "disables" it for 20-30 minutes) you get a remarkable increase in working memory (nearly a doubling, if memory serves me).
  - qq4 5y ago
    Whoa, that sounds really interesting. Source by any chance?

Trias11 5y ago

It even hurts to read the title.

golem14 5y ago
Ha. There's a short story in which the narrator is invited to a dinner to eat monkey brain, but is tricked and consumed himself. Can't remember the author or name of the story (would think ea Poe or Roald Dahl). Was making a big impression on me when I first read it as a child. Anyone knows the story ?
noisy_boy 5y ago
I strongly recommend you never watch Red Dragon: https://www.imdb.com/title/tt0289765/ https://www.imdb.com/title/tt0289765/

carl_dr 5y ago

I didn’t see that it was stated what the surgery was for, and I am unfamiliar with deep brain stimulation. For anyone else in the same boat, for the author, it is a method of managing the symptoms of Parkinson’s disease. A fascinating read.

insickness 5y ago
> Normally if I had gone till noon without any medication I would have had a pronounced tremor Yeah, probably some type of Parkinson's.
casion 5y ago
He has another post describing that he has parkinsons: https://tmrwedition.com/2021/01/30/pros-and-cons-of-four-different-brain-surgeries-for-parkinsons-disease/ https://tmrwedition.com/2021/01/30/pros-and-cons-of-four-dif...
DoingIsLearning 5y ago
Small correction, DBS is not limited to just Parkinson's treatment. Although Parkinson's is the most common disease to be treated with DBS, the technique is used in a broad set of diseases/conditions where you have some form of dystonia. Source: Worked on a Neurosurgery software suite a few years back.

insickness 5y ago

> I did wonder, what would it be like if something went wrong... What would I experience? Would the world suddenly go dark? Would my conscious awareness and this chain of experience I call my self suddenly shift to something else? I think this would have been an important question to ask the surgeon prior to surgery. What if something goes wrong?

hsbauauvhabzb 5y ago
Probably about the equivalent of ‘undefined behaviour, in a computer program - maybe you segfault, maybe you unlock the ability to speak Spanish fluently. It all depends on the when and where.

UI_at_80x24 5y ago

I've had fully awake brain-surgery. 1990 I was under 16 years of age. I had a tumor causing epileptic seizures. I had my right-temporal lobe completely removed. I was talking to the surgeon while he worked on me. They needed to communicate to (a) make sure they didn't affect my speech center, and (b) try to manually trigger a seizure (aura) to test if they were close. I smell burnt toast Dr Penfield. [ https://www.youtube.com/watch?v=pUOG2g4hj8s https://www.youtube.com/watch?v=pUOG2g4hj8s ] The most painfull part of the procedure was getting the needles under my scalp to numb the skin (a local anesthesia) before they drilled in. The mostly used hand-tools. 2 holes were drilled (using a hand-drill). They created a large reverse question mark, going from infront of my ear (in my sideburn), up around the 'corner' of my head, and then back towards the back of my head. They used a hacksaw, and then the flap that was left over was laid back onto my head. I'll be happy to answer any questions that anybody may have.

souldeux 5y ago
I'm not quite sure how to phrase this, but here goes: during this procedure did you experience anything that you feel you could not have experienced absent someone physically poking your brain?
- UI_at_80x24 5y ago
  In short, no. The operation itself lasted for over 12hrs, but I am only aware of (approximately) the first hour. So weird shit may have happened, but I have no memory of it.
  - ibizaman 5y ago
    How come you only remember the first hour?
    - UI_at_80x24 5y ago
      Mostly because I had severe head trama! =) lol At some point they put me out, so that messes with your memory too, but I think `brain surgery` is a good reason to not being able to remember. If you get into a car accident and hit your head or get a concussion you don't remember everything either.

polishdude20 5y ago

How do they put in the wires into the brain without messing up some critical parts along the way?

pineal 5y ago
The neurosurgeon meticulously plans the exact trajectories prior to surgery and we use a combination of software and hardware (Stealth or Brainlab) to ensure we follow the planned path. Of course, complications still occur but are fairly rare, serious or permanent ones even more so.
- polishdude20 5y ago
  Are they actually piercing into the brain matter or are there gaps in the brain? Does the trajectory avoid actual neurons on the way?
  - pineal 5y ago
    The brain matter is indeed pierced. While “you only use 10% of your brain” is a myth, much of the brain is what we call non-eloquent, meaning it can be damaged or removed without any noticeable effects. Especially when it just means being pierced by a 2-3mm diameter lead. Are there hidden side effects that we are simply unable to recognize? Sure, but with as primitive an understanding of the brain as we currently have, we are forced to rely on a more pragmatic rather than philosophical approach.
    - polishdude20 5y ago
      Great answer! That explains so much thanks.

peanut_worm 5y ago

If I ever had something that would require this I would prefer to just be euthanized or something. I cannot even read this article without recoiling in horror. I am sure there are other people with a phobia of surgery like myself, what do they do for those people? I would definitely faint before entering the operating room.

deltabravosam 5y ago
I have something that does require this and I couldn't finish the article. I have no idea what I'm going to do. I'm facing potentially fatal seizures or DBS.
- UI_at_80x24 5y ago
  I want to help. I can call you if you want, or offer my phone number for you to call me. It's not bad. You don't feel ANYTHING. If you've ever been to the dentist and had a cavity filled then that is the extent of the horror. The sounds are no worse, just different. There is no reason to suffer. Let's talk about this. (It's 23:15 Eastern, I'm going to bed soon. But we can also talk tomorrow.) Here's the number you can reach me at: 313-524-1974 My name is Matt.
  - kmote00 5y ago
    You are being a serious bro, Matt, and I commend you for it! But I would hate to see you get deluged by phone spam as a result. Please consider spelling out the letters of some of the digits in your phone number before it gets scraped.
    - EGreg 5y ago
      I always wondered, years have gone by, haven't spammers figured out how to scrape numbers from all the little tricks we have done over the years? Maybe even a reverse GPT-4 type AI?
    - UI_at_80x24 5y ago

khana 5y ago

are you kidding?

knownjorbist 5y ago

Here's an incredible video detailing a DBS procedure, treating a woman with essential tremor. It is remarkable how you can see her symptoms improve in realtime via her movements and handwriting. https://www.youtube.com/watch?v=isYY2jvd8PU https://www.youtube.com/watch?v=isYY2jvd8PU

noisy_boy 5y ago

> During which time my hair was cut, but only the parts that might get in the way of the procedure, giving me that classically handsome friar tuck look Of the many weird things I wonder about, this has been on the list for a while. Why was that totally weird haircut done? To make clergy even more irresistible than they already were? Some kind of trying to both having and eating your cake by having hair while not having hair?

jaggirs 5y ago
Your surgeon is not your hairdresser. He cut away what he needed to cut away, if you want to cut away more later you can do it yourself.
- s4vo 5y ago
  The question was about the specific hairstyle ('friar tuck'-like) being done at all and not why the surgeon did it in this story.
mbg721 5y ago
https://en.wikipedia.org/wiki/Tonsure https://en.wikipedia.org/wiki/Tonsure It's apparently meant to evoke a crown representing the victory to be gained in the afterlife through humility on earth, in imitation of St. Peter.

lwhi 5y ago

Reading this makesme

lwhi 5y ago

Oh my - reading this makes me feel very funny. I don't think of myself as that squeamish; but anything involving sculls, brains and drilling me makes me feel instantly queasy. Amazing that this is having a positive effect, but sweet lord .. I find it difficult to even think about.

capaneus 5y ago

I was fitted with a deep brain stimulator for dystonic tremor in 2012. Their were two operation two weeks apart. In the first operation the battery was put in my chest and six screws place around my skull. Scans are done to calculate the location they want to place the electrodes relative to the screws. The second operation was done under local anaesthetic, they drilled two holes in the skull and inserted the electrodes