Deep Brain Stimulation: Symptoms, Classification, Diagnosis & Recovery

Deep Brain Stimulation (DBS) is a treatment primarily used for movement disorders such as Parkinson's disease, essential tremor, and dystonia. The decision to undergo DBS involves a comprehensive evaluation and diagnosis process. Here are key aspects of the diagnosis and testing for DBS treatment:

• Comprehensive Neurological Evaluation: A thorough assessment by a neurologist or movement disorder specialist is conducted to evaluate the patient's medical history, symptoms, and overall health.
• Confirmation of Diagnosis: The underlying movement disorder, such as Parkinson's disease or essential tremor, is confirmed through clinical examination and possibly additional diagnostic tests like imaging studies (MRI or CT scans).
• Response to Medication: Patients are typically considered for DBS if their symptoms are not adequately controlled with medication or if they experience medication-related side effects.
• Neuropsychological Evaluation: A neuropsychological assessment may be conducted to evaluate cognitive function, mood, and other factors that can impact the overall suitability for DBS.
• Imaging Studies: High-resolution brain imaging, such as MRI or CT scans, is performed to visualize the structures within the brain and identify the optimal target for electrode placement.
• Trial Stimulation (Microelectrode Recording): In some cases, a trial stimulation may be conducted during surgery using microelectrode recording to confirm the optimal placement of the electrodes and assess their impact on symptoms in real-time.

During the deep brain stimulation therapy, the neurosurgeon first uses an 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 anesthetic before the procedure, and then the neurosurgeon implants the 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. A 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.

The surgeon schedules a time to program the generator a few weeks following surgery. The generator continuously pulses electricity into the brain once it has been programmed. With the help of a specialized remote control, the Patient may operate the generator and switch it on or off.

• Typically, patients need to stay in the hospital until their incision-related pain is under control, and they can eat, drink and walk. Mostly, the patients are required to stay for only one night at the hospital after the surgery, but some patients 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 the 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.