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Deep Brain Stimulation

Deep brain stimulation is a surgical process in which electrodes are inserted into some parts of the brain. These electrodes commonly known as leads produce electrical impulses that help to control the abnormal activity of the brain. These electrical impulses also normalize the chemical components in the brain that can lead to several conditions. 

Stimulation of the brain is controlled by a programmed generator that is positioned in the skin over the upper chest. Doctors can use deep brain stimulation for neuropsychiatric conditions or movement disorders when prescribed medications become less effective or cause side effects and disturb the normal physiology of the patient. 

The DBS system consists of three different components. 

  • Electrode/lead- It is a thin and insulated wire inserted through a small opening in the skull and placed at specific areas of the brain. 

  • Extension wire- It is also an insulating wire that is passed under the skin of the neck, shoulder and head. It connects the electrode to the internal pulse generator (IPG). 

  • Internal Pulse Generator (IPG)- It is the third part of the system and is placed under the skin in the upper chest. 

How does DBS work? 

Movement or locomotion-related disorders such as Parkinson’s disease and other neurological conditions occur due to disorganized electrical signals in certain areas of the brain that control locomotion. When successful, deep brain stimulation interrupts the irregular electrical signals that cause tremors and other movement-related symptoms. 
  During the process, neurosurgeons implant one or more leads inside the brain. These leads are further connected to an extension wire that establishes a connection between leads/ electrodes to a small neurostimulator (internal pulse generator).    After a few weeks of the neurostimulator insertion, the doctor programs it to deliver electrical signals. This programming process may require more than one visit in the week or month to ensure that the neurostimulator is adjusting current properly and providing effective results. The doctor keeps in mind to establish an optimal balance between reducing the side effects and improving the symptoms while adjusting the device.  

Who needs Deep Brain Stimulation? 

DBS involves a series of procedures, evaluations and consultations before and after the surgery so that patients who are willing to get this treatment can devote sufficient time to the process.    The cost for the DBS process, pre-operative and post-operative follow up can vary according to the patient’s insurance coverage. 

The process can improve movement-related symptoms of Parkinson’s disease and other conditions, but it doesn’t guarantee to provide perfect health to the patient. 

Parkinson’s disease 

DBS can benefit three types of PD patients- 

  • Patients having uncontrolled tremors and medications haven’t provided desired results. 

  • Patients experiencing severe motor fluctuations and dyskinesia after withdrawal of drugs. 

  • Patients whose movement symptoms respond to higher and more frequent medication doses, but are unable to do so due to side effects. 

Essential Tremor 

Essential tremor is the most common locomotion disorder. DBS can be an effective treatment for this condition in cases where shaking limits daily activities like shaving, dressing, etc.   

Dystonia 

Dystonia is an uncommon movement disorder. Its symptoms include twisting movements and abnormal postures. DBS can help to improve the symptoms. However, the response of the patient depends on the cause of the condition, which may be genetic or drug-induced. 

What is the process of deep brain stimulation?   

There are two methods to conduct DBS. In some cases, the doctor inserts both the neurostimulator and leads in the patient. And in other cases, two surgeries are required separately, to implant the leads and neurostimulator.   

Stereotactic DBS and interventional image-guided DBS

In stereotactic DBS surgery, the patient requires to get himself off his medications. During the process, a frame stabilizes the patient’s head and give coordinates to help the surgeon guide the electrode to the correct positions in the brain. The patient receives local anaesthesia to keep himself comfortable during the entire process along with a mild sedative to keep him relaxed. 
  In image-guided DBS surgery, the patient is given general anaesthesia and is fall asleep in an MRI or CT scan machine. The surgeon uses MRI and CT images to guide the electrodes to the desired locations in the brain. Generally, this method is recommended for children, patients having extreme symptoms or those who are anxious and fearful.    The following is the general procedure for DBS surgery. 

Lead Implantation

  • The patient's jewellery, clothing and other objects are removed that may cause interference during the procedure.

  • The medical team will shave a small part of the head and injects anaesthesia into the scalp so that they can place the head frame.

  • With the help of the screws, the head frame is attached to the skull.

  • The surgical team then uses MRI or CT to point out the target area in the brain where the lead will be attached.

  • After giving some medications, the surgeons make a small hole in the skull to insert the lead.

  • When the lead moves through the brain, the neurosurgeons record the process to check the correct location of the lead.

  • Once the lead is in the correct position, it is then connected to the neurostimulator. Electrical stimulation conducted will help doctors analyse if the symptoms are improved or any side effects have occurred.

  • An extension wire is attached to the lead connecting the neurostimulator. This wire is placed under the scalp.

  • The hole made in the skull is closed with the stitches and plastic cap.

Microelectrode Recording

MER (microelectrode recording) uses a current of high frequency to find the accurate surgical area for implanting the DBS (deep brain stimulator). As the structure of each person is different, therefore, the MER gives correct information about the surgical site for placing the DBS. The microelectrode allows the surgeons to hear and see the neuronal activity from different parts of the brain.

Placement of the Neurostimulator

To carry out this process efficiently, the person is given anaesthesia. After this, the medical team inserts the neurostimulator under the outer skin like the collarbone, abdomen or chest. The extension wire is attached to the lead connected to the neurostimulator.

After DBS (Deep Brain Stimulation) Surgery

In The Hospital The hospital stay after the deep brain stimulation surgery is about 24 hours or longer depending on the recovery of the patient. The doctors will visit the patients at regular intervals and give instructions and advice for home care.

At Home The patient needs to keep their incisions dry and clean. The doctors will provide instructions about how to care for yourself at home till the surgical area heals. A magnet is given to the patient that can be used to turn off or on the neurostimulator under certain conditions.

Specific Precautions After DBS (Deep Brain Stimulation) Surgery

The patients who had DBS should:

  • Carry an ID card with themselves that states they have a neurostimulator. They can also wear a bracelet that indicates this information.

  • Tell the airport security that they carry a neurostimulator before going through the detector. They should inform the security who have handheld detectors not to use this device for a longer period as they may affect the functions of the neurostimulator.

  • Consult their physicians before going through any type of MRI procedure. Also, they should visit places with large magnetic fields like automobile junkyards or power generators that use large magnets.

  • Not use heat in physical therapy to cure their muscle problems.

  • Not use radar or high-voltage machines like smelting furnaces, television transmitters, radar installations or high-tension wires.

  • Inform the surgeons about the neurostimulator before going for other surgery. They should take precautions before and during the surgical process. 

  • Protect their pacemakers or neurostimulators while performing any physical activity.

How can CARE Hospitals help?

At CARE Hospitals, we follow international treatment protocols to provide comprehensive care and treatment for brain-related disorders. Our well trained medical team provides assistance and end to end care to help patients have a healthy life. 
 

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