Deep brain stimulation (DBS) is a surgical procedure to treat neurological conditions. It involves placing a pacemaker under chest skin, below the collarbone, which sends electronic impulses to a part of the brain that controls movements.
DBS is generally an option when traditional medications or therapy are not effective to treat neurological disorders. It helps patients to reduce medication and return to normal life.
It is typically used for conditions like Parkinson’s disease, dystonia, tremors, etc that are resistant to other forms of treatment. The procedure involves two parts:
Signals are generated from the pacemakers and sent to the brain, which block the impulses that cause tremors in various parts of the body.
Deep brain stimulation involves creating small holes in the skull to implant the electrodes, and surgery to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:
Deep brain stimulation is hence a cost vs. benefits problem. For many patients with treatment-resistant forms of Parkinson’s disease and other movement disorders, DBS can help them return to a normal life and regain quality of life.
Deep brain stimulation is not a cure, it is a way to manage unmanageable symptoms that interfere with normal functions.
An ideal candidate for DBS surgery is under 70 years old and is in good health. Patients who fluctuate between “on” and “off” medication states are usually good surgical candidates, as are those who have troublesome dyskinesias.
DBS is a surgical procedure that delivers high-frequency electrical stimulation to precise areas of the brain. This is done by implanting a thin wire with electrodes at the tip. The electrodes are precisely placed into a brain site that carries the abnormal signals producing the symptoms. High frequency stimulation will alter these abnormal signals, thereby leading to symptom improvement. The location of electrode placement varies based on the illness being treated.
Prior to the procedure, a pre-operative evaluation is performed in order to maximize the success of DBS surgery. The evaluation may include brain MRI scan, neuropsychological testing, videotaped evaluation of movement both on and off medication, and others if indicated.
The precise placement of the electrodes is achieved both by MRI measurement as well as intraoperative microelectrode mapping. Once the electrodes are placed, the wire is connected to the neurostimulator power supply (a battery-operated generator), which is placed under the skin near the collarbone. The system, often called a brain pacemaker, regulates the abnormal signals resulting from the disease process.
Once the electrodes and the impulse generator are securely in place, the electrodes send electrical impulses that help normalize abnormal impulses. In other words, it will help block faulty signals within the brain that cause tremors or other movement symptoms to occur. No healthy tissue is destroyed with this procedure.
Brain surgery. For the brain surgery portion, your care team fits you with a special head frame to keep your head still during the procedure (stereotactic head frame). Then, team members use magnetic resonance imaging (MRI) to map your brain and identify the area in your brain where they’ll place the electrodes.
Surgery can be done under general anesthesia so that you’ll be unconscious. Or the procedure can be done with you awake and alert. If you’re awake for surgery, you’ll be given a local anesthetic to numb your scalp before the procedure, but you won’t need an anesthetic in your brain itself because the brain has no pain receptors.
Your surgeon implants a thin wire lead with a number of contacts (electrodes) at the tips into a specific area of your brain. Or one lead is implanted into each side of the brain (for a total of two leads). A wire runs under your skin to a pulse generator (neurostimulator) implanted near your collarbone.
During surgery, both the neurologist and surgeon carefully monitor your brain to help ensure correct electrode placement.
Chest wall surgery. During the second portion of the surgery, the surgeon implants the part of the device that contains the batteries (pulse generator) under the skin in your chest, near your collarbone.
General anesthesia is used during this procedure. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated pulse generator.
The generator is programmed to send continuous electrical pulses to your brain. You control the generator, and you can turn it on or off using a special remote control.
The patient is expected to stay in the hospital for 1-2 days after the surgery. Recovery time is quick, though there might be disorientation or itchiness near the stitches initially.
During the recovery time after implanting the electrodes, you may feel better than normal. Brain swelling around the electrode tip causes a lesion effect that lasts a couple days to weeks. This temporary effect is a good predictor of your outcome once the stimulator is implanted and programmed.
About a week later, you will return to the hospital for outpatient surgery to implant the stimulator in the chest/abdomen. This surgery is performed under general anesthesia and takes about an hour. Patients go home the same day.
Deep brain stimulation won’t cure your disease, but it may help lessen your symptoms. If deep brain stimulation works, your symptoms will improve significantly, but they usually don’t go away completely. In some cases, medications may still be needed for certain conditions.
Deep brain stimulation isn’t successful for everyone. There are a number of variables involved in the success of deep brain stimulation Surgery. It’s important to talk with your doctor before surgery about what type of improvement you can expect for your condition.
Q.How long does deep brain stimulation surgery take?
A. The length of the operation also depends on the technique used by each center, but it often lasts between 3-6 hours from start to finish. As long as the electrodes are accurately placed, without complications, the recovery period usually lasts from between 3 to 5 days.
Q. What is the success rate of deep brain stimulation surgery in India?
A. Studies report that DBS Surgery can reduce off -periods of PD symptoms by 60% (fluctuations in motor symptoms due to poor response to medicines). By reducing the need for medication, DBS Surgery rapidly decreases medication-induced dyskinesias by 60 to 80% and improves the quality of life in people with advanced PD.