Deep brain stimulation (DBS) is a procedure that involves placing electrodes within certain regions of the brain, where the electrodes create electrical impulses that control abnormal impulses, or the electrical impulses can impact certain cells and chemicals within the brain. The quantity of stimulation generated in DBS is regulated by a pacemaker-like device that is placed under the skin in the upper chest. This is connected by a wire that travels beneath the skin to the electrodes in the brain.
Deep brain stimulation is generally used to treat several health conditions like:
It is also being examined as a possible treatment for:
Huntington's disease and chorea
Purpose Of The Test
This procedure is a well-recognised treatment for a person with mobility problems such as essential tremor, Parkinson's disease and dystonia, and psychiatric conditions, such as obsessive-compulsive disorder. Furthermore, it’s also certified by the Food and Drug Administration to lessen seizures in patients with hard-to-treat epilepsy. This is a treatment option for people whose symptoms cannot be managed with medications.
The procedure is generally considered to be low risk, as with any type of surgery has certain risk of complications. Also, brain stimulation can lead to certain side effects.
This procedure involves making a small hole in the skull to implant electrodes into the brain tissue, as well as surgery is done to implant the device that comprises the batteries to be placed beneath the skin in the chest. Some of the complications that may arise due to the surgery include:
Misplacement of leads
Bleeding in the brain
Possible side effects after surgery may include:
Temporary pain and swelling at the implantation site.
A few weeks later the surgery, the device will be turned on and the process of finding the correct settings for the person starts, this may cause side effects, but often ease with further adjustments of the device.
Possible side effects of stimulation:
Muscle tightness of the face or arm
Sudden mood changes, such as anger and depression
How To Prepare For The Procedure
DBS is a serious and possibly risky procedure, even if a person is eligible for the procedure, the healthcare provider must weigh the risk and potential benefits of the procedure.
Before the surgery, the person may need certain tests to ensure that DBS is a safe and right option. Further, the person may also need imaging studies like an MRI, before the surgery. These tests may help to identify regions of the brain that will have the electrodes implanted.
What To Expect?
During The Surgery
For brain surgery, the doctor will place a special head frame to keep the head intact during the procedure. Then, surgery panel members use neuroimaging (brain MRI or CT) to locate the brain and identify the region in the brain where they will place the electrodes. In most cases, the electrodes will be placed while the patient is awake and alert. This ensures the effects of stimulation can be tested completely. Local anaesthesia is given to numb the scalp before the procedure, but usually, a person may not need an anaesthetic in the brain, as the brain has no pain receptors.
Then the surgeon will graft a thin wire lead with several electrodes at the tips into a particular region of the brain. One lead is implanted into each side of the brain, where a wire runs beneath the skin to a neurostimulator implanted near the collarbone.
While during the procedure, both the neurologist and the surgeon carefully evaluate the brain to ensure correct electrodes are placed.
Chest Wall Surgery
During the second part of the surgery, the surgeon will implant a part of the machine that contains the batteries (pulse generator) beneath the skin in the chest near the collarbone. General anaesthesia is given during the procedure, where wires from the brain electrodes are placed under the skin and guided down to the battery-operated pulse generator.
The generator is designed to send continuous electrical pulses to the brain. It is operated with a special on and off remote control.
After The Procedure
A week later surgery, the pulse generator that is placed in the chest is activated in the doctor’s clinic. The doctor can easily program a pulse generator from outside the body using a special remote control. The correct amount of stimulation is tailored as per the health condition and it may take as long as four to six months for the healthcare provider to find the best setting.
The stimulation may be kept constant, 24 hours a day or the doctor may suggest the patient turn the pulse generator off at night and back on in the morning, depending upon the health condition. The patient can also operate it with help of special remote control. In a few cases, the doctor may program the pulse generator to allow you to make minor alterations at home.
The battery life of the generator varies with usage and settings. When the battery requires to be replaced, the surgeon will replace the generator during an outpatient visit.
Deep brain stimulation procedure won’t really cure the disease, but it may help to alleviate symptoms. If DBS procedure works symptoms will improve remarkably, but they typically don’t settle fully. In some cases, medications may be needed for certain health problems.This procedure may not be successful for all. There are several variables involved in the success of DBS. Hence, it’s essential to talk with a health care provider before surgery about what type of improvement one can expect of the condition.