3 ms·

Fortunately, or unfortunately depending on how you view it, brains don't seem to work like that. The likelihood of DBS being able to turn someone into an ideal

Fortunately, or unfortunately depending on how you view it, brains don't seem to work like that. The likelihood of DBS being able to turn someone into an ideal worker/consumer is about the same as it being able to turn a Parkinson's patient into an Olympic athlete.

caycep 5y ago
I would generally agree with this...the electrodes and microcontrollers we have tend to be relatively crude. BUT...I would say apathy as a broad symptom/syndrome is known to be associated w/ an untreated Parkinsonian state...so if some enterprising postdoc somehow finds a target nucleus that improves apathy w/ macro stimulating electrodes in the near future...we could all be wrong..
- omgwtfbyobbq 5y ago
  That might be possible, but it's likely more of a person to person difference than something that can be reliably used. Even with people with PD, whether and how well DBS will work is variable, and even after it's put in, assuming it works for someone, programing is about finding a good balance between beneficial effects and unwanted side effects. Even if there is a target to improve apathy, it'll likely come at the expense of some other unwanted side effects.
  - caycep 5y ago
    The problem w/ PD-DBS is...the practice of implanting and programming the gizmos is much less standardized that it should be. Yes, there is some patient to patient variability...but you can kind of predict what will happen and how the patient will respond simply by mapping the anatomical location of the electrodes using Lead DBS or FSL or ANTS. The folks with well placed electrodes - the pro-movement/anti-tremor effect is remarkably consistent. The folks who either are implanted a few millimeters outside of the targeted nucleus, or roll in the door with some bizarre setting...not so much... That being said, I have heard for less measurable symptoms, i.e. OCD or depression...DBS implantation and programming is much more inexact, as you describe.
    - omgwtfbyobbq 5y ago
      I think it depends on the person. My mom's experience isn't that uniform. Every MDS sees her high pulse width (for PD I guess), is like "Hold my beer.", and tries something that works out worse than the settings she's had since she first got DBS in 2005. It is night and day for tremor, but it also has significant trade-offs. Granted, it could be that the targeting wasn't ideal to begin, after 15+ years she needs her leads redone, or something else, but from what I've seen it really is a set of trade-offs. I remember watching a video by a guy who just got DBS talking about something similar with a researcher and I'll edit this post if I can find it.
      - caycep 5y ago
        it is hard to say...anecdotally, I've seen generally that the further the electrode is located away from the posterior subthalamic nucleus, the higher the PW is needed to achieve any effect. Maybe the electrode probably needs it to send current over further distances. But it may be helpful to map things out if imaging is available. Targeting has probably come a long way too. I remember pulling old MRI's from cases done in 2003 or so, and they just look so fuzzy and crude compared with modern machines...

caycep 5y ago

I would generally agree with this...the electrodes and microcontrollers we have tend to be relatively crude. BUT...I would say apathy as a broad symptom/syndrome is known to be associated w/ an untreated Parkinsonian state...so if some enterprising postdoc somehow finds a target nucleus that improves apathy w/ macro stimulating electrodes in the near future...we could all be wrong..

omgwtfbyobbq 5y ago
That might be possible, but it's likely more of a person to person difference than something that can be reliably used. Even with people with PD, whether and how well DBS will work is variable, and even after it's put in, assuming it works for someone, programing is about finding a good balance between beneficial effects and unwanted side effects. Even if there is a target to improve apathy, it'll likely come at the expense of some other unwanted side effects.
- caycep 5y ago
  The problem w/ PD-DBS is...the practice of implanting and programming the gizmos is much less standardized that it should be. Yes, there is some patient to patient variability...but you can kind of predict what will happen and how the patient will respond simply by mapping the anatomical location of the electrodes using Lead DBS or FSL or ANTS. The folks with well placed electrodes - the pro-movement/anti-tremor effect is remarkably consistent. The folks who either are implanted a few millimeters outside of the targeted nucleus, or roll in the door with some bizarre setting...not so much... That being said, I have heard for less measurable symptoms, i.e. OCD or depression...DBS implantation and programming is much more inexact, as you describe.
  - omgwtfbyobbq 5y ago
    I think it depends on the person. My mom's experience isn't that uniform. Every MDS sees her high pulse width (for PD I guess), is like "Hold my beer.", and tries something that works out worse than the settings she's had since she first got DBS in 2005. It is night and day for tremor, but it also has significant trade-offs. Granted, it could be that the targeting wasn't ideal to begin, after 15+ years she needs her leads redone, or something else, but from what I've seen it really is a set of trade-offs. I remember watching a video by a guy who just got DBS talking about something similar with a researcher and I'll edit this post if I can find it.
    - caycep 5y ago
      it is hard to say...anecdotally, I've seen generally that the further the electrode is located away from the posterior subthalamic nucleus, the higher the PW is needed to achieve any effect. Maybe the electrode probably needs it to send current over further distances. But it may be helpful to map things out if imaging is available. Targeting has probably come a long way too. I remember pulling old MRI's from cases done in 2003 or so, and they just look so fuzzy and crude compared with modern machines...