Deep brain stimulation

What is a deep brain stimulation?

Deep brain stimulation (DBS) comprises implanting electrodes within areas of the brain. The electrodes generate electrical impulses that affect brain activity to treat certain medical conditions. Electrical impulses can also affect cells and chemicals within the brain, which can cause medical conditions.

The stimulation's amount in deep brain stimulation is controlled by a pacemaker-like device placed below the skin in the upper chest. A wire that travels under the skin joins this device to the electrodes in the brain.

This procedure is predominantly utilized to treat an array of conditions, like:

• Parkinson's disease.
• Essential tremor.
• Conditions that cause dystonia, like Meige's syndrome.
• Epilepsy.
• Tourette syndrome.
• Obsessive-compulsive disorder.

This procedure is also being studied as an efficient treatment for:

• Chorea, like Huntington's disease
• Long term pain
• Cluster pain in the head
• Dementia
• Depression.
• Addiction.
• Abnormal weight gain

How to prepare

First, weigh the pluses and minuses

Deep brain stimulation is a severe and potentially risky procedure. If an individual is eligible for deep brain stimulation, weigh the risks and potential perks with the healthcare team.

Furthermore, prepare for surgery

Before surgery, a person will likely require medical tests to ensure that deep brain stimulation is a safe and excellent option for him/her. Person also may require brain-imaging studies, like an MRI, prior to the surgery. These studies aid to map the areas of brain where the electrodes are implanted.

During the Procedure

Typically, here's how surgery for deep brain stimulation works:

Brain surgery: For brain surgery, the healthcare care team fits a person with a unique head frame known as a stereotactic head frame. The frame keeps head still during the procedure. Then, neuroimaging, for instance, brain MRI or CT is utilized to map a person's brain. The imaging pinpoints the proper area in a person's brain to place the electrodes.

The majority of the time, the electrodes are placed while the person is awake and alert. This is to ensure the effects of stimulation can be tested completely. If person is awake for surgery, person will likely be administered a local anaesthetic to numb scalp prior to the procedure. Person won't need an anaesthetic in brain itself because the brain has no pain receptors. In some people, surgery can be done utilising a medicine that puts person to sleep, known as general anaesthesia.

Surgeon implants a fine wire lead with several electrodes at the tips. The lead is placed into a specific portion of brain. Few people have leads placed into each side of the brain for a total of two leads. A wire passes under person's skin to a device called a pulse generator implanted in proximity to collarbone.

During surgery, both the neurologist as well as the surgeon vigilantly monitor person's brain to aid ensure correct electrode placement.

Chest wall surgery: During the second half of the surgery procedure, the surgeon implants the pulse generator under the skin of the chest, proximity to the collarbone. This part of the device comprises the batteries.

A medication that puts person to siesta, known as general anaesthesia, is utilised during this procedure. Wires from the brain electrodes are kept under the person's skin and guided down to the battery-operated pulse generator.

Several weeks post-surgery, the generator is programmed during an appointment with healthcare professional. Post it's programmed, the generator transmits continuous electrical pulses to brain. Person can control the generator and can turn it on/off utilising a special remote control.

After the Procedure

A few weeks post-surgery, the pulse generator in the chest is activated, usually in a healthcare professional's office. The pulse generator can be programmed from exterior to the body using a special remote control. The amount of stimulation is customized to the condition. It may take as long as 4-6 months to assess the optimal setting.

Stimulation may be continual, 24 hours a day, or the person may be told to turn the pulse generator off at night and back on in the morning. This depends on the person's condition. The person can turn stimulation on and off with a remote control that the person takes home with him/her. Sometimes, the pulse generator may be programmed to let the person make minor alterations at home.

The pulse generator's battery life varies with its use and settings. When the battery needs to be replaced, the surgeon will substitute the generator during an outpatient procedure.

Advantages of deep brain stimulation (DBS)

DBS has several advantages. These comprise:

It can provide a treatment choice when medications aren't useful: DBS is a choice when medications don't work or are no longer effective. With Parkinson's disease, medications lose effectiveness over period of time, so healthcare providers must increase a person's dosage. That leads to other side effects. With DBS, lower medication dosages are often effective again, which means manifestations are under control with decreased side effects.

It can be a life-changing (or even lifesaving) treatment: Few of the conditions that DBS treats can cause severe effects that keep a person from doing even the majority of routine activities. DBS can treat a person's condition and improve manifestations, enhancing overall life's quality. For conditions like medication-resistant epilepsy, where surgical resection isn't a choice, DBS can perpetuate hope and reduction in seizure frequency.

It's adjustable: Healthcare providers can fine-tune the pulse generator settings to analyse what works best for the person.

It's reversible: If DBS doesn't work or causes side effects that the person can't tolerate, a follow-up surgery can take out the leads and pulse generator.

Risks

They may comprise:

• 1% likelihood of brain haemorrhage, comprising stroke
• Infection
• Device malfunction
• Lack of benefit for certain manifestations
• Pain in the head
• Worsening mental or emotional status

During stimulation, side effects may comprise:

• Temporary tingling in the face or limbs
• A sensation of pulling in muscles
• Speech/vision issues
• Loss of balance

To summarise, deep brain stimulation (DBS) refers to a neurosurgical procedure that utilises implanted electrodes and electrical stimulation to treat movement disorders linked with Parkinson's disease (PD), essential tremor, dystonia as well as other neurological conditions.

DBS is safe and effective in properly chosen patients. Risks and potent side effects do exist, but they are usually mild and reversible.