Deep brain stimulation
Deep brain stimulation is a surgical procedure that uses an implanted medical device to deliver carefully controlled electrical stimulation to the specific structures that control movement and muscle function in the brain. This stimulation can offer relief from rigidity, tremors, stiffness, slow movements as well as essential tremor (a common neurological movement disorder). Movement disorders refer to conditions that cause abnormal voluntary or involuntary movements. Disorganized electrical signals in specific areas of the brain cause symptoms. Those challenged with essential tremors, Parkinson's disease, dystonia, and other neurological conditions may benefit from deep brain stimulation (DBS), especially when symptoms progress or medications become less effective.
Procedure
Before the Procedure
- Ask your doctor whether you should stop taking any drugs, and make sure you have the all-clear before surgery.
- Stop taking all non-steroidal anti-inflammatory medicines such as ibuprofen,naproxen, etc. and blood thinners a week before surgery.
- Stop smoking and drinking alcohol before the surgery to avoid bleeding and healing problems.
- You should not eat or drink anything at least 8 to 12 hours prior to the surgery.
- A neurosurgeon may use magnetic resonance imaging (MRI) or CT scan prior to the procedure to identify the exact location within the brain where electrical nerve signals generate the neurological symptoms.
- Microelectrode recording (MER), which involves a small wire that monitors the electrical activity of nerve cells in the target area, may be used by some surgeons to identify the brain target that will be stimulated more precisely.
During the Procedure
- The deep brain stimulation system consists of mainly three components, namely, the lead, the extension, and the neurostimulator.
- A lead, which is also called an electrode, is a slender wire that is insulated and inserted in the brain through a small opening in the skull. The electrode's tip is positioned within the area of the brain being targeted.
- The extension is an insulated wire that connects the lead to the neurostimulator by passing it through the skin of the head, neck, and shoulder.
- The third component is the neurostimulator, which is usually implanted near the collarbone under the skin. It may also be implanted in the lower chest region or under the skin over the abdomen in some cases.
- Once the deep brain stimulation system is in place, electrical impulses are transmitted from the neurostimulator up the extension wire and lead then into the brain. The electrical signals that cause neurological symptoms are interfered with and are blocked by these impulses.
- Insertion of the leads and neurostimulator is typically accomplished in two steps. First, the neurosurgeon places the leads either into one or both sides of the brain, and this is often performed while the patient is awake. In a second procedure, the neurostimulator is implanted in the chest while the patient is asleep.
After the Procedure
- In general, the hospital stay following deep brain stimulation surgery is 24 hours, but it may be longer depending on the patient's recovery. The doctor will visit to ensure the patient is ready to leave and provide instructions for home care.
- It is critical to keep the incisions clean and dry at home. While the surgical site heals, the doctor will instruct the patient on bathing. If stitches or sutures are done, they will be removed during a subsequent visit. If adhesive strips are present, they should be kept dry and will usually fall off within a few days.
- Following the placement of the leads and neurostimulator, the patient is advised to visit the doctor to have the programming neurostimulator for optimal electrical stimulation. Although doctors may activate the neurostimulator before the patient is discharged from the hospital, programming usually begins a few weeks after the procedure.
- Programming takes time, and adjusting the neurostimulator settings may necessitate multiple appointments. Simultaneously, the doctors will address the patient's medications and dosages, ensuring that the medications work effectively with the electrical stimulation to control symptoms.
Benefits
Deep brain stimulation can:
- DBS can help you live a better quality of life by reducing tremors and improving motor function.
- DBS works round the clock, so you rely less on medication to control your symptoms. You may continue to take medication if it helps.
- DBS can be adjusted. The settings on your neurostimulator (implanted pulse generator) can be changed to increase its effectiveness and reduce any side effects.
- DBS can be reversed. The implanted pulse generator can be turned off so that you can try new treatments that become available.
- DBS can continue to work for years. The implanted pulse generator's batteries last three to five years. It is easily replaced in an outpatient procedure. Newer rechargeable generators have a lifespan of about 15 years before needing to be replaced.
Risks
Deep brain stimulation is a safe procedure that rarely has complications. But any surgery has risks. With DBS, risks include:
- Brain hemorrhage, which could be insignificant or may cause paralysis, stroke, speech impairment, or other serious problems.
- Infection
- Bleeding in the brain
- Stroke
- Part of the DBS system is malfunctioning
- The implanted pulse generator may not be working
Care at Medicover
At Medicover, we have an eminent team of neurosurgeons offering comprehensive diagnosis and treatment to get to the root of the problem and offer services with advanced technology tailored to suit the individual needs of the patients. We are equipped with state-of-the-art facilities and world-class technology, offering comprehensive treatment for neurological disorders such as parkinson’s disease etc. Our latest technology offers the patient faster recovery time and advanced care at an affordable cost.
