Deep brain stimulation

Deep brain stimulation is FDA approved for treating the tremor associated with Parkinson's disease. It is not approved yet for the treatment of depression, but clinical research over the last couple of years has been promising.

Clinical research trials are not available at the Mayo Clinic at this time, but are at a couple of sites both in and outside of the United States. It is not clear exactly how this "brain pacemaker" works, but it is thought that the electrical impulses generated by the stimulator reset the brain. This is theorized to return brain functioning to normal (including neurotransmitter levels, such as serotonin, norepinephrine, dopamine, etc.) and thus, treating the depression. As with electroconvulsive therapy (ECT), this is a treatment reserved for severe, debilitating depression.

Deep brain stimulation requires a neurosurgical procedure. During the surgery, electrodes are implanted deep into the brain. Wires from the stimulator are attached to a battery operated stimulator that is implanted in the chest. The battery, stimulator, wires, etc. do have the potential to malfunction. This may require replacement of parts later on. Because this is an invasive procedure, it carries definite risks, some of which are life-threatening. These include, but are not limited to:

• Bleeding in the brain
• Infection
• Delirium
• Unwanted mood changes
• Movement disorders
• Lightheadedness
• Insomnia

In addition, people who have undergone deep brain stimulation to treat Parkinson's disease have reported such side effects and adverse events as panic attack, speech difficulty, movement problems and even suicide.

Since this is a relatively new treatment, long term effects are not known. As with any treatment, discussion with your physician is important so you can understand the risks, benefits and alternatives. Weighing all of the pros and cons is crucial in the decision making process. This will ensure that you are making an informed decision by putting your health care as top priority.

Coronary artery spasm

A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood flow to part of the heart muscle (myocardium). If the spasm lasts long enough, it can lead to chest pain (angina) and possibly a heart attack (myocardial infarction). These spasms may also be referred to as Prinzmetal angina or variant angina. Unlike typical angina, which usually occurs with exertion, coronary artery spasms often occur at rest.

Coronary artery spasms occur most often in people with risk factors for heart disease, such as tobacco use, high cholesterol and high blood pressure. They may also be associated with other diseases, such as lupus. Coronary artery spasms may be triggered by tobacco use, exposure to cold, extreme emotional stress and use of illicit stimulant drugs, such as amphetamines and cocaine.

Treatment of coronary artery spasms may include medications such as nitrates, calcium channel blockers and 1-arginine, which may reduce the risk of recurrence. You can also reduce your risk by discontinuing tobacco use and controlling high cholesterol and high blood pressure.