Deep Brain Stimulation (DBS) is a neurosurgical procedure to implant a device that transmits electrical signals to areas of the brain responsible for body motion.
Deep brain stimulation treatment is like that of a cardiac pacemaker in which the pacemaker helps to maintain healthy heart rhythm. It is believed that DBS helps to modulate abnormal pathways in the brain so that the brain can function better. This is achieved by transmitting continuous electrical signals to particular target areas in the brain. Further, it blocks the impulses that result in neurological dysfunction. There are 3 target areas in the brain, they are the ventral intermediate nucleus of the thalamus (Vim), the globus pallidus pars interna (GPi), and the subthalamic nucleus (STN).
The DBS system consists of three components, such as:
- The Lead is an electrode which is a thin insulated wire inserted through a small opening in the skull and placed in the brain.
- The extension is an insulated wire which is passed below the skin of the head, neck and shoulder, joining the lead to the internal pulse generator (IPG).
- The third component is the IPG or neurostimulator which is usually placed near the collarbone under the skin. It is also placed in the chest or under the skin over the abdomen in some cases.
How is DBS performed?
Under a local anaesthetic, a small opening is made in the skull. During the DBS procedure, the patient is awake to allow the surgical team to monitor their brain functions. While the lead (electrode) is advancing through the brain, because of the unique inability of the human brain to generate pain signals the patient does not feel pain.
In the DBS procedure, a computerized brain mapping technology is used to determine the precise location in the brain where the tremors and other symptoms are caused by nerve signals. A highly advanced imaging and recording equipment are used to map both the physical structure and the functioning of the brain. The electrodes are connected to an internal pulse generator (IPG), which is placed in the chest wall via wires.
With the IPG, a magnet is used to modify the stimulation parameters so that the proper stimulation level is applied at the tip of the electrode. To turn the IPG on and off at home the patient is provided with an access control device or handheld magnet. The battery can last from three and five years, depending on the product. The IPG is also replaced when the battery needs replacement, usually, under local anesthesia, this outpatient procedure is performed by a neurosurgeon.
Risks after DBS surgery are:
1. Allergy
2. Dizziness
3. Loss of balance
4. Speech or vision problems
5. Minimal coordination
6. Concentration problems
Deep Brain Stimulation (DBS) has been used for several decades to reduce intractable pain. The use of this technology has proven to be a safe and powerful treatment for critical tremors, as well as tremor and involuntary movements linked with Parkinson’s disease, dystonia and multiple sclerosis. Other conditions for which deep brain stimulation treatment is needed are Epilepsy, Essential tremor, Obsessive-compulsive disorder, Dementia, Multiple sclerosis, Traumatic brain injury, and Huntington’s disease.
Benefits of DBS Surgery are:
1. DBS procedure can be done on both sides of the brain to manage symptoms.
2. The effects of the DBS procedure are reversible.
3. Devices can help monitor and manage symptoms 24 hours a day.
With more than 35,000 DBS implants worldwide, the applications for DBS treatment are expanding rapidly.
