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What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a surgical procedure in which a brain pacemaker, known as a neurostimulator is implanted. The brain pacemaker delivers constant electrical impulses to particular areas of the brain.
The deep brain stimulation system comprises the following:
- An electrode, which is a long, thin insulated wire placed in the brain
- A neurostimulator, which is commonly implanted near the collarbone
- An insulated wire that connects the electrode to the neurostimulator
A rigid frame is used to ensure that the electrode is correctly placed in the specific area of the brain. The patient may need to remain awake in the initial stage of the surgery to report any sensorial changes.
After it is connected, the neurostimulator sends electrical impulses through the extension wires to the electrode and into the brain. This helps in reducing certain symptoms of movement disorder and tremors.
What diseases are treated with DBS?
Deep brain stimulation is used to treat Parkinson’s disease, Tremor and Dystonia.
It may not fully cure Parkinson’s disease, but it decreases the severity of the symptoms.
How is a DBS Surgery Performed?
Deep brain stimulation surgery is usually done in two stages. In the first stage, the patient is usually awake under local anesthesia. The patient’s head is placed in a rigid frame. Screws are used to fix the head to the frame. A small hole is drilled in the skull and the electrode is placed in the particular part of the brain. If the surgery needs to be performed on both parts of the brain, two holes are made on both sides of the skull and two electrodes are inserted. Small amounts of electrical impulses are sent over the electrode to ensure that it is properly connected to the specific area of the brain that is causing the patient’s symptoms. Various neurological tests may be performed.
In the second stage of the surgery, general anesthesia is administered on the patient and the patient remains unconscious throughout the surgery. A small incision is made below the collarbone. The neurostimulator is implanted under the skin. In some cases the neurostimulator is placed in the lower chest area. Another incision is made behind the patient’s ear. An extension wire is passed under the skin from the head, neck and shoulder. This extension wire connects the electrode to the neurostimulator. The incision is closed and the wires and the device are concealed inside the body.
What are the Pre-surgical Preparations for Deep Brain Stimulation?
Duration of procedure/surgery:
- The patient will have a physical examination.
- The patient needs to do a CT scan and MRI scan to locate the specific region of the brain that causes tremors and symptoms of movement disorder.
- The patient should inform the doctor about:
- The patient’s health conditions, such as pregnancy
- Any medication that the patient is taking
- Alcohol that the patient may be consuming
- Some medications that the patient is taking may be stopped a number of days before the surgery.
- The patient should avoid smoking.
- The doctor may ask the patient’s hair to be washed with a special shampoo on the night before the surgery.
The duration of the surgery depends on the steps involved, which may vary. If two electrodes are inserted, then the duration is longer. Some surgeries could take approximately 5 hours or more.
Approximately 3 days
- The first stage of the surgery is done under local anesthesia.
- The second stage of the surgery is done under general anesthesia.
- If the surgery is performed on children, both the stages
- The patient may be required to take antibiotics to prevent infection.
- The patient may need to visit the neurologist several times after the surgery to adjust the stimulation with the help of programming.
- The medications of the patient are adjusted after the surgery.
- The stitches or staples are removed in 7 to 10 days after the surgery.
There are several risks of deep brain stimulation. However, if it is performed on properly selected patients, it is safe and effective. The risks of deep brain stimulation are as follows:
- Allergic reaction to the implanted devices
- Concentrating problems
- Cerebrospinal fluid leakage leading to meningitis
- Dizziness and balance loss
- Movement disability
- Vision and speech defect or disability
- Swelling of the surgical site where the devices are implanted
- Breakage or dysfunction of the implanted devices and wires
- Brain swelling
- The incision area should be kept dry and covered, and should be changed according to the requirements.
- The patient’s head can be washed using a damp cloth carefully avoiding the surgical region.
- The day after the stitches or staples are removed, the patient’s hair can be washed gently.
- The patient should avoid scratching the surgical wound.
- Light activities, such as housework and sexual activity, should be avoided for 2 weeks after the surgery.
- Heavy physical activities, such as jogging and swimming, should be avoided for 4 to 6 weeks after the surgery.
- The patient should avoid lifting heavy objects for 2 to 4 weeks after the surgery.
- If the doctor permits, the patient may return to work in 4 to 6 weeks after the surgery.
- Some places may contain devices such as theft detectors, which may affect the neurostimulator that causes an uncomfortable sensation. The patient should always carry a medical identification card to request assistance to avoid such devices.
- A magnet will be provided to activate or deactivate the neurostimulator. This magnet may harm other devices like TV or credit cards. So the magnet should be kept away from these devices.
- The batteries of the pulse generator need to be replaced in 3 to 5 years. This can be done in an outpatient procedure.
If the following symptoms are experienced, the doctor should be contacted immediately:
- Severe headaches
- Bleeding from the surgical area
- Infection or irritation in the incision area
- Vision impairment
- Nausea and vomiting
- Speech difficulty
- Numbness or a tingling sensation on a part of the body
Learn more about Deep Brain Stimulation