A Comprehensive Guide to Deep Brain Stimulation Treatment

Deep brain stimulation (DBS) is a neurosurgical procedure that involves the 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 procedures are used to treat several disorders, such as:

Parkinson's disease
Dystonia
Epilepsy
Tourette syndrome
Obsessive-compulsive disorder
Chronic Pain

Deep brain stimulation uses a neurostimulator, commonly referred to as a deep brain stimulator, to deliver electrical stimulation to targeted areas in the brain that control movement.

The impulse sent by the deep brain stimulator interferes with and blocks the electrical signals that cause tremors 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.

A pacemaker-like device inserted under the skin in the upper chest regulates the amount of stimulation during deep brain stimulation. The electrodes in the brain are connected to this device by a wire that passes beneath the skin.

Deep brain stimulation treatment has proven effective in most 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.

The signs and symptoms related to DBS are more associated with the underlying neurological conditions it is designed to address rather than being inherent to the stimulation itself. Here are some signs and symptoms related to the neurological disorders often treated with DBS:

Parkinson's Disease: Involuntary shaking of hands, arms, legs, jaw, or head.
Bradykinesia: Slowness of movement.
Rigidity: Stiffness in the limbs and trunk.
Postural Instability: Impaired balance and coordination.
Essential Tremor: Trembling or shaking, particularly during purposeful movements.
Dystonia(Involuntary Muscle Contractions): Twisting or repetitive movements affecting various body parts.
Obsessive-Compulsive Disorder (OCD): Intrusive, unwanted thoughts or images.
Repetitive behaviors or mental acts are performed to alleviate anxiety.
Epilepsy: Abnormal electrical activity in the brain leading to convulsions, loss of consciousness, or altered behavior.

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.

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.