Deep Brain Stimulation – Let’s Know It

What is DBS and how can it help a Parkinson’s patient? Answer to these questions is crucial for Parkinson’s patients in the later stage of their disease. To understand the uses and benefits of DBS, let’s first know what is Parkinson?

 

Parkinson’s is a dynamic disorder in which your brain stops creating chemical which controls the body’s motor movements. In any case, there is no fix treatment of this disease but it can be dealt with using different techniques which include drug, treatments and DBS. Now let’s discuss what is DBS?

What is DBS?

DBS is a surgical procedure which treats a variety of neurological symptoms such as tremor, rigidity, stiffness in muscles and walking problems. DBS doesn’t damage the healthy brain tissue by destroying nerve cells but instead, this procedure blocks electrical signal from targeted sections in the brain.

 

DBS can easily be often described as a pacemaker for the brain, sending electrical signals to the brain. It is important to understand that DBS does not offer a permanent treatment for your disease but it’s a way to manage it more conveniently and effectively.

 

The deep brain stimulation system consists of four parts:

 

  • Leads (thin insulated wires) that end in electrodes that are implanted in the brain.
  • A small pacemaker-like device, called a pulse generator, creates the electrical pulses.
  • Extension leads that carry electrical pulses from the device and are attached to the leads implanted in the brain.
  • Hand-held programmer device that adjusts the device’s signals and can turn the device off and on.

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Advantages of DBS Surgery

A primary benefit of DBS is helping to reduce muscle disorder in the body, however, there are a few other advantages of Deep Brain Stimulation (DBS) that you should know about. Some advantages of DBS are listed below.

 

  1. DBS does not cause permanent damage in any part of the brain.
  2. The electrical stimulation is adjustable and reversible as the person’s disease changes or his/her response to medications change.
  3. Since DBS is reversible and causes no permanent brain damage, the use of innovative not-yet-available treatment options may be possible.
  4. The stimulator can also be turned off at any time if DBS is causing unnecessary side effects without any long-term consequences.

Benefits: What does the research say?

Researchers have studied at some of the benefits of DBS for various medical conditions which cause muscular or motor disorders in the body; some of whom are listed below.

 

Parkinson’s Disease

 

In 2009, a study gave 255 people with advanced Parkinson’s disease either DBS or the best alternative care doctors were able to recommend.

 

Those who were suffering from DBS saw an average increase of 5 hours a day of good symptom control, while the other group did not see this benefit. The DBS group also saw improvements in motor function and quality of life.

 

However, 40 percent of the participants who received DBS also had adverse effects, including infections from the surgery.

 

Following further investigations and clinical trials, the Food and Drug Administration (FDA) approved the use of DBS in 2015 for people who have had Parkinson’s disease for at least 4 years with complications that medications cannot control.

 

Tremor

 

In 2010, a team from the University of South Florida followed 34 people with essential tremor for an average of 56.9 months after DBS surgery.

 

Overall, participants showed an improvement of just over 80 percent on their tremor scores and nearly 70 percent on handwriting scores.

 

The researchers concluded that the treatment was safe and effective, but they warned that tolerance might develop in some people and symptoms could return.

Surgery: What to expect?

Most people who have DBS need two separate surgeries to implant the necessary equipment. First, the surgeon will implant the electrodes in the brain. Special scanning equipment will guide them to the correct location.

 

The surgeon generally begins by fitting a stereotactic head frame to ensure that the person’s head remains still during the procedure. They apply local anesthesia to numb the scalp.

 

Next, they implant a thin wire with electrodes into the brain, followed by a neurostimulator near the collarbone.

 

The individual needs to be awake sometimes during the procedure, so that the neurologist and neurosurgeon can ask questions to monitor his/her brain function.

 

A day later, the surgeon implants a pulse stimulator in the person’s chest during a second procedure involving chest wall surgery. The surgeon will make a small opening behind the ear, pass the extension wire under the skin, and connect it to the neurostimulator.

 

When the surgery is complete, the neurostimulator will send electrical pulses to the brain.

Steps to take After Deep Brain Stimulation Surgery

There are a few guidelines you have to be aware of after the DBS surgery. Some of these precautionary guidelines are as follows.

 

  • Individuals may encounter a slight, temporary shock or tingling as placement during the initial programming of DBS.
  • Pacemakers are generally put in the same pocket in the chest where DBS stimulators are placed. Since the pacemakers are
  • placed on the left side of the chest, the DBS stimulator could be placed on the right side of the chest.
  • Individuals with Parkinson disease or dystonia will be instructed to leave the stimulator on continuously. There is no need to turn off the stimulators unless undergoing a medical procedure.
  • Adjusting a deep brain stimulation device to meet a patient’s needs takes time.
  • Patients begin meeting with treatment centre, 4 to 6 weeks after the surgery.
  • Usually, patients will establish their optimal stimulation settings in two to three months following surgery.
  • Finding the correct contact on your DBS lead can only be done by the DBS neurologist or nurse who does the initial programming.
  • If the stimulator battery runs out, if you have Parkinson you should contact your neurosurgeon or the STIM team as soon as possible.
  • DBS process takes time as there is no formula because everyone is unique.
  • Sometimes it happens faster, and sometimes it takes longer, in some cases it may take a year to find the correct DBS settings.
  • Patients may also feel some discomfort related to the device’s neurostimulator (or battery pack), which is implanted under the skin near the collar bone.
  • You can make at-home adjustments to your deep brain stimulation programming.
  • The latest generation of DBS devices allow patients the ability to adjust their stimulation levels within certain limits, in addition to the adjustments made by their doctor and nurse.

 

Luckily, the recovery time for the surgery itself is relatively short, and most patients can quickly return to their normal daily routine while they work with experts to program the device.

 

Apart from a few days of post-surgical pain, which doctors treat with a mild analgesic, DBS patients typically do not experience much pain.

Disclaimer – The above statements are for informational purposes only. Please take advice of a trained medical professional before acting on any of the above statements.