Deep brain stimulation (DBS)

Overview

Deep brain stimulation (DBS) is a surgery to implant a device that sends electrical signals to targeted brain area responsible for body movement. Electrodes are placed deep in the brain and are connected to a stimulator device. Similar to a heart pacemaker, a neurostimulator uses electric pulses to regulate brain activity. DBS can help reduce the symptoms of tremor, slowness, stiffness, and walking problems caused by Parkinson's disease, dystonia, or essential tremor. Successful DBS allows people to potentially reduce their medications and improve their quality of life.

What is Deep Brain Stimulation?

In deep brain stimulation, electrodes are placed in targeted  area of the brain depending on the symptoms being treated. The electrodes are placed on both the left and right sides of the brain through small burr holes made at the top of the skull. The electrodes are connected by extensions that travel under the skin and down the neck to a battery-powered stimulator under the skin of the chest. When turned on, the stimulator sends electrical pulses to block the faulty nerve signals causing tremors, rigidity, and other symptoms.

Who is a candidate? (DBS is suitable for )

DBS is used for  treating many of the symptoms caused by the following movement disorders:

  • Parkinson's diseasetremor, rigidity, and slowness of movement caused by the death of dopamine-producing nerve cells responsible for relaying messages that control body movement.
  • Essential tremor: involuntary rhythmic tremors of the hands and arms, occurring both at rest and during purposeful movement. Also may affect the head in a "no-no" motion.
  • Dystonia: involuntary movements and prolonged muscle contraction, resulting in twisting or writhing body motions, tremor, and abnormal posture. May involve the entire body, or only an isolated area. Spasms can often be suppressed by "sensory tricks," such as touching the face, eyebrows, or hands.                               

 

Application

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Frequently asked questions (FAQs)

Frequently asked questions (FAQs)

 Would DBS therapy prevent me from using future treatments or cures that may come along?

 No. DBS therapy will not reduce your future therapy options. DBS therapy is reversible and the system can be removed.

 Is DBS just for tremor?

 No, DBS also treats stiffness and slow or absent movement and may provide relief from some non-motor symptoms, such as sleep disturbance.

 Is DBS something to put off as a last resort?

 No. The window of opportunity for DBS Therapy opens when your body isn't responding to medication as well as it used to, but before your medicine stops working completely. If you wait too long, DBS Therapy will not be able to help you as much as it could have done earlier.

 How long will it take for DBS to work after the implant procedure?

Each person responds to DBS differently but it generally takes several months. Usually you need to heal fully from surgery before programming can begin and you will then need several programming sessions before you achieve good symptom control.

What does the stimulation feel like?

Most people don't feel the stimulation. However, some people may feel a brief tingling sensation when the stimulation is first turned on. If the stimulation changes or becomes uncomfortable, contact your doctor immediately.

Does the brain stimulation system make any noise?

No.

Will I be able to resume my normal daily activities?

For the first few weeks after surgery, you should avoid strenuous activity, arm movements over your shoulder, and excessive stretching of your neck. You may gradually want to try activities that were difficult before your surgery. Talk about this with your doctor first, and make sure you follow all of your doctor's instructions.

Will the neurostimulator be visible?

Depending on your body build, the neurostimulator may be noticeable as a small bulge under the skin. However, your doctor will try to place the neurostimulator where it is most comfortable and cosmetically acceptable.

Is it safe to have medical tests with the system implanted?

Consult your doctor before you have any medical treatment or diagnostic test (for example, MRI scan, mammogram, or heart defibrillation).

Can stimulation be used during pregnancy?

It is recommended by most of the doctors that the patient should not use any medical and/or surgical procedure unless it is necessary. However, with our pregnant cases, we did not encounter any side effect so far. 

Is this a permanent procedure?

DBS is a reversible procedure. It is also adjustable, which means that the stimulation can be adjusted to match changes in your symptoms. The system can be deactivated or even removed through further surgery.

What happens if the neurostimulator stops working?

Your symptoms will return. If you can't determine the possible cause and correct the problem, contact your doctor.

How long will the neurostimulator battery last?

This depends on the type of system used. Your neurosurgeon will be able to advise. If the neurostimulator battery needs to be replaced, this will be done through surgery, before the battery runs out. Typically the leads and extensions will stay in place and simply be reconnected to the new neurostimulator.

Some systems use rechargeable batteries, reducing the need for further surgery to replace batteries.