Deep Brain Stimulation

Deep brain stimulation (DBS) is a neurosurgical procedure that involves implantation of electrodes within the specific targeted areas of the brain. It is used to treat a variety of disabling neurological symptoms. Deep brain stimulation procedure can be opted for treating a number of neurological conditions, including Parkinson's disease, Essential tremor, Dystonia, Epilepsy, Tourette syndrome, obsessive-compulsive disorder and chronic pain. Deep brain stimulation uses a neurostimulator, commonly referred to as deep brain stimulator,  to deliver electrical stimulation to targeted areas in the brain that control movement.

The impulse sent by deep brain stimulator interferes with and blocks the electrical signals that cause tremor and other Parkinson’s disease symptoms. The targeted areas most often include the thalamus, subthalamic nucleus and globus pallidus. Deep brain stimulation procedure has a long history of research. It was first introduced in 1987 and The Food and Drug Administration (FDA) approved deep brain stimulation treatment for essential tremor and Parkinson's disease in 1997.

What is deep brain stimulation treatment?

Deep brain stimulation treatment is recommended for people who have had Parkinson’s disease for at least four years, are still getting benefited from medications, but have motor complications, such as significant on-off time periods. Brain stimulation therapy works by inactivating the parts of the brain that cause Parkinson's disease symptoms. However, DBS Parkinson does not damage the healthy brain tissue by destroying nerve cells. It blocks electrical signals from targeted areas of the brain.

Deep brain stimulation treatment has proven effective in most of the cases, but it could potentially result in serious complications and side effects. This is the main reason why deep brain stimulation treatment is used only for patients whose symptoms are not appropriately controlled with medications.

During the deep brain stimulation therapy, the neurosurgeon first uses magnetic resonance imaging (MRI) or computed tomography (CT) scan to identify the exact target within the brain where electrical nerve signals generate the symptoms. Some doctors may use microelectrode recording (a small wire that observes the activity of nerve cells in the target area) to more specifically and precisely identify the target in the brain that will be stimulated during the treatment.

After identifying the targets in the brain, there are several ways in which the permanent electrodes are placed into the target areas. The patient is given a local anaesthetic before the procedure, and then the neurosurgeon implants electrode by making small holes in the skull. The implanted electrodes are connected with extensions (a thin insulated wire) connected with the stimulator. These extensions are passed by some incisions under the skin of the head, neck, and shoulder. Deep brain stimulator is a battery-operated medical device similar to a heart pacemaker. It is implanted under the skin near the collarbone or in the chest.

Typically, patients need to stay in the hospital until their incision-related pain is under control, they are able to eat, drink and walk. Mostly, the patients are required to stay for only one night at the hospital after the surgery, but some patient may be advised to stay for at least two nights. The patient will not be able to shower or wet the area around the incision until the wound has completely healed. Deep brain stimulation programming takes place about 3 to 4 weeks after the surgery and this is when the actual benefits of the treatment can be reaped.

After a few weeks of surgery, the neurostimulator (IPG) is activated by a specialist. The specialist can easily program the IPG from outside the patient’s body using a special remote control. The amount of stimulation is customized as per specific needs. Stimulation may be constant or the specialist may advise to turn the IPG off at night and back on in the morning, depending on the condition of the patient. The batteries of stimulator may last for three to five years. The IPG replacement procedure is relatively simple. Inform your doctor immediately in case you experience any problems related to speech, balance, and coordination or in case you experience mood swings, numbness, muscle tightness, or lightheadedness.

There are many  benefits of deep brain stimulation, including the following:

• It gives patients an average of five more hours of symptom-free time every day.
• It does not involve the use of medicine and most patients are able to reduce their medication usage after they undergo treatment, which means fewer drug-induced side effects.
• It does not reduce future therapy options. It is reversible and the stimulator can also be turned off at any time if it is causing some uncommon side effects.
• Deep brain stimulation systems are designed so that an MRI head scan is possible with proper safeguards.
• Brain stimulation therapy does not require purposeful destruction of any part of the brain. Therefore, it has fewer complications than other therapies such as pallidotomy and thalamotomy.
• The electrical stimulation is adjustable and can be changed as per the patient's disease response to medications change.