Deep brain stimulation is a way to functionally modulate various nuclei in brain like subthalamic nucleus, the thalamus or globus pallidus without purposefully destroying or structurally altering the brain tissue. In deep brain stimulation, electrodes are placed in the thalamus (for essential tremor and multiple sclerosis) or in the subthalamic nucleus or globus pallidus (for Parkinson's disease or PD). The electrodes are connected by wires to a type of pacemaker device (called an impulse generator, or IPG) implanted under the skin of the chest, below the collarbone.
Once activated, the device sends continuous electrical pulses to the target areas in the brain, modifying the brain circuits that are responsible for motor symptoms of PD. This is better than thalamotomy or pallidotomy as it can be modulated as per needs of the patient and can be done without actually destroying parts of the brain.
The IPG can easily be programmed using a computer that sends radio signals to the IPG. Patients are given special magnets so they can externally turn the IPG on or off.
DMS typically involves two separate surgeries:
§ Brain surgery - Firstly, doctors have to identify the region of the brain where the electrodes will be implanted. This is done by analyzing the results of an MRI scan.
Before surgery a stereotactic head frame is fixed to ensure that the patient's head remains still throughout the whole procedure.
Local anesthesia is used to numb the scalp, and a thin wire with electrodes is implanted into the brain. Afterwards, a neurostimulator is implanted near the collarbone.
Patients must be awake during the procedure so that the neurologist can ask questions to make sure the correct areas of the brain are being stimulated.
Before surgery a stereotactic head frame is fixed to ensure that the patient's head remains still throughout the whole procedure.
Local anesthesia is used to numb the scalp, and a thin wire with electrodes is implanted into the brain. Afterwards, a neurostimulator is implanted near the collarbone.
Patients must be awake during the procedure so that the neurologist can ask questions to make sure the correct areas of the brain are being stimulated.
§ Chest wall surgery - a day or two after the brain surgery, a pulse stimulator is implanted within the patient's chest.
A small opening is made behind the ear and the extension wire passes under the skin and connects to the neurostimulator.
The stimulator is programmed to send electrical pulses to the brain.
A small opening is made behind the ear and the extension wire passes under the skin and connects to the neurostimulator.
The stimulator is programmed to send electrical pulses to the brain.
Why is deep brain stimulation performed?
Some people suffering from severe Parkinson's disease cannot be controlled on medications, and additional methods of alleviating symptoms, such as DBS, are necessary.
Results of a two-year clinical trial found that DBS greatly improves overall quality of life and social functioning among patients in earlier stages of Parkinson's disease.
In addition to treating Parkinson's disease, DBS can help treat the symptoms of the following conditions and problems:
§ Dystonia - the largest follow-up record of patients with the most common form of hereditary dystonia reported very good success rates and lasting benefits from DBS.
§ Tremors - DBS helped a significant number of patients stop taking medications used to treat their essential tremors within one year following the surgery.
§ Rigidity
§ Trouble walking
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The doctor may advise few antibiotics to prevent infection. The patient may need to visit the doctor several times after the surgery to adjust the stimulation with the help of programming. The doctor may prescribe a detailed medication plan to the patient. The patient should take some precautions after the surgery and follow the instructions given by the doctors. He/she should take care of the incisions and the surgical region on the head, by keeping it dry and covered. Heavy physical activities and lifting heavy weights should be avoided for few weeks after the surgery. Regular follow-up with the treating doctor should be done.
Deep Brain Stimulation Surgery Advantage:
· In this surgery we do not injure the brain so it is relatively risk free.
· Completely reversible and programmable
· Parkinson medications are reduced which results in improvement of drug related side effects.
· There is improvement of quality of life in both off and on stage of the disease.
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