What is Deep Brain Stimulation

Deep brain stimulation (DBS) is an elective surgical procedure in which electrodes are implanted into certain brain areas. These electrodes, or leads, generate electrical impulses that control abnormal brain activity. The electrical impulses can also adjust for the chemical imbalances within the brain that cause various conditions. Stimulation of brain areas is controlled by a programmable generator placed under the upper chest’s skin.

The Deep brain stimulation system involves three distinct components:

• The electrode, or lead, is a thin, insulated wire inserted through a small opening in the skull and implanted into a specific brain area.
• The extension wire is also insulated and passed under the head, neck and shoulder skin, connecting the electrode to the internal pulse generator (IPG).
• The IPG is the third piece of the system and is usually implanted under the skin in the upper chest.

Deep brain stimulation is commonly used to treat several conditions, such as:

• Parkinson’s disease
• Essential tremor
• Dystonia
• Epilepsy
• Obsessive-compulsive disorder

Deep brain stimulation is also being studied as a potential treatment for:

• Chronic pain
• Tourette syndrome
• Cluster headache
• Huntington’s disease and chorea

Causes

Deep brain stimulation is a surgical intervention used to treat patients with movement disorders such as Epilepsy,  essential tremor, Parkinson’s disease, and dystonia. It can also be used to control symptoms of obsessive-compulsive disorder and epilepsy. This procedure is utilised when medications are no longer effective for patients maintaining a good quality of life.

These diseases affect hundreds of thousands of people worldwide. DBS has been used to treat over 160,000 people for various neurological conditions.

Symptoms

Each disease type has a variety of symptoms that patients may experience. Common ones are:

Dystonia

• Involuntary muscle contractions occurring during specific actions (e.g. writing)
• Muscle contractions worsen with stress, fatigue or anxiety

Epilepsy

• Temporary confusion
• A staring spell
• Loss of consciousness
• Uncontrollable jerking movements of arms or legs
• Emotional responses such as fear, anxiety or déjà vu

Essential Tremor

• Tremor occurring during daily activities like writing or drinking

Obsessive-compulsive Disorder (OCD)

Fear of germs or contamination

• Aggressive thoughts towards others or one’s self
• Having things in symmetrical or in perfect order
• Excessive cleaning or handwashing
• Compulsive counting
• Checking things repeatedly (e.g. oven is off, the door is locked, etc.)

Parkinson’s Disease

• Tremors
• Bradykinesia – slowing down of movement
• Stiffness
• Abnormal walking

Does deep brain stimulation work immediately?

For most, results are noticed shortly after the initial programming of Deep brain stimulation device. However, adjusting the settings for maximal benefit could take several visits. Your physician will work with you to adjust the parameter settings to find the optimal symptom control without side effects.

Does deep brain stimulation last forever?

Research indicates that subthalamic nucleus deep brain stimulation improves motor function for up to 10 years, although the magnitude of improvement can decline over time.

What are the Risks of Deep Brain Stimulation?

Although deep brain stimulation is generally considered to be low risk, any surgery has the risk of complications. Also, the brain stimulation itself can cause side effects.

Surgery risks

Deep brain stimulation (DBS) involves creating small holes in the skull to implant the electrodes into the brain tissue and performing surgery to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:

• Misplacement of leads
• Slight risk of bleeding in the brain (1%)
• Stroke
• Infection
• Breathing problems
• Nausea
• Heart problems
• Seizure

Possible side effects after surgery

Side effects associated with deep brain stimulation may include:

• Seizure
• Infection
• Headache
• Confusion
• Difficulty concentrating
• Stroke
• Hardware complications, such as an eroded lead wire
• Temporary pain and swelling at the implantation site

The device will be turned on a few weeks after the surgery, and the process of finding the best settings for you begins. Some settings may cause side effects, but these often improve with further adjustments to your device.

Because there have been infrequent reports that Deep brain stimulation therapy affects the movements needed for swimming, the Food and Drug Administration recommends consulting with your doctor and taking water safety precautions before swimming.

Possible side effects of Deep Brain Stimulation

• Numbness or tingling sensations
• Muscle tightness of the face or arm
• Speech problems
• Balance problems
• Lightheadedness
• Vision problems, such as double vision
• Unwanted mood changes, such as anger and depression

What are the advantages of DBS Surgery?

• Depending on symptoms, DBS can be performed on one or both sides of the brain.
• The effects are reversible and can be customised individually for each patient’s clinical status.
• DBS Stimulation settings can be modified to diminish potential side effects and improve effectiveness over time.
• The DBS device can provide continuous symptom control 24 hours a day.
• Patients who have undergone DBS can participate in other treatments, such as stem cell or gene therapy, when they become available.