Deep brain stimulation (DBS)
- Article
- 2021-03-07
Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of disabling neurological symptoms - usually the disabling motor symptoms of Parkinson's disease (PD), such as tremor, stiffness, stiffness, slowed movement, and walking difficulties. The procedure is also used to treat essential tremor, dystonia, and focal epilepsy (epilepsy that occurs in only one part of the brain). Currently, the procedure is only used for individuals whose symptoms cannot be adequately controlled with medications. Only individuals who improve to some extent after taking Parkinson's medications will benefit from DBS.
DBS uses a surgically implanted, battery-operated medical device called an implantable pulse generator (IPG) - similar to a heart pacemaker and about the size of a stopwatch - to deliver electrical stimulation to specific areas of the brain that control movement. regulating the abnormal nerve signals that cause symptoms. The DBS system consists of three components: the lead, the extension and the IPG. The lead (also called an electrode) - a thin, insulated wire - is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is located in the specific brain area. The extension is an insulated wire that passes under the skin of the head, neck, and shoulder and connects the lead to the implantable pulse generator. The IPG (the "battery pack") is the third component and is usually implanted under the skin near the collarbone. In some cases, it can be implanted lower in the chest or under the skin above the abdomen.
Before the procedure, a neurosurgeon uses magnetic resonance imaging or computed tomography scanning to identify and locate the exact target in the brain for surgery. Generally these areas are the thalamus, the subthalamic nucleus and the globus pallidus.
Once the system is in place, electrical impulses from the IPG are sent up the extension wire and up the lead to the brain. These impulses block abnormal electrical signals and relieve motor symptoms.
Therapy
DBS uses electrical stimulation to regulate electrical signals in neural circuits to and from identified areas of the brain to improve movement symptoms. So if DBS causes unwanted side effects or develop newer, more promising treatments in the future, the implantable pulse generator can be removed and the DBS procedure discontinued. Also, the stimulation of the IPG is easy to adjust - without further surgery - if the person's condition changes. Some people describe pulse generator settings as "programming."
DBS involves minimal permanent surgical change in the brain. While DBS is minimally invasive, it is a surgical procedure that carries some risk. There is a small chance that placement of the stimulator could lead to bleeding or infection in the brain. Complications can include bleeding and swelling of brain tissue, headache, seizures, and temporary pain after surgery.
Prognosis
Most people still need to take medication after undergoing DBS. Many people with Parkinson's disease experience a significant reduction in their motor symptoms after DBS and can reduce their medications. People with dystonia may respond better to DBS than medications in reducing involuntary muscle contractions. DBS targeting the thalamus can improve involuntary movements of the hands, arms and head associated with involuntary tremor. DBS for epilepsy can reduce seizures over time. DBS does not improve and may actually worsen cognitive symptoms in PD, so it is generally not used when there are signs of dementia. DBS changes the brain's firing pattern, but it does not slow the progression of neurodegeneration.
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