Deep Brain & Motor Cortex Stimulation

What is Deep Brain Stimulation (DBS)?

Deep brain stimulation (DBS) is an established treatment therapy for people with neurological movement disorders which are poorly controlled with medications.

The DBS surgical procedures involve a neurostimulator (device) implanted under the skin in the chest/collarbone and it delivers the DBS therapy. Electrodes are placed within certain areas of the brain and connected to the neurostimulator in the upper chest. Similar to the pacemaker for the heart, the device generates electrical pulses through the electrodes to regulate the brain activity. These continuous pulses disrupt some of the brain’s messages that cause the symptoms associated to movement disorders and achieve the therapeutic effect.

People living with DBS therapy is now able to have better management of their symptoms, reduce in intake of medications which leads to an improved quality of life.

Unlike, other surgeries such as pallidotomy or thalamotomy, the DBS procedure IS reversible and does not damage the brain tissues.

Components of Deep Brain Stimulation System

A deep brain stimulation system consists of implanted and external components. The components as follows:

The implanted components:

• Neurostimulator — Rechargeable or non-rechargeable implanted neurostimulator (device) that generates electrical pulses and is usually surgically implanted under the skin in your upper chest
• Leads — A set of thin insulated medical wires with a protective coating and electrodes near the tip that transmit electrical pulses to the stimulation site
• Extension — Insulated wire that connects the lead to the neurostimulator. It is placed under skin from the scalp, behind the ear, down the neck and to the chest where the neurostimulator is placed

How DBS Works?

A small pacemaker-like neurostimulator placed under the skin just beneath the collarbone. The neurostimulator generates 24 hours electrical impulses through the lead wires to the precise location in the brain that controls movement. With DBS therapy, you are now able to better manage your symptoms – improves motor function, decrease your medications, and improves ability to perform activities of daily living.

DBS Surgery

A team of multi-disciplinary specialists which includes a neurologist, neuropsychologist, nurse specialist and neurosurgeon will evaluate your medical condition to determine if DBS surgery is recommended. You will undergo clinical assessments (e.g. Unified Parkinson Disease Rating Scale – UPDRS) and record your movement symptoms which later used for discussion by the multi-disciplinary team for surgery decision.

Once DBS surgery is an option, you will schedule for an appointment with a neurosurgeon to run through with you on what entails before, during and after the DBS surgical procedure.

DBS surgery is a minimally invasive procedure and generally the entire surgery procedure lasts 5-6 hours. Before the surgery, patient is required to perform Brain MRI where the images will be used during the operation day. The surgery consists of two stages. For stage 1, patient is required to go for a CT scan with a head frame in place. The neurosurgeon will use the pre-operative MRI images and CT image to determine the best trajectory of the target area in your brain for leads placement. Before placement of the permanent leads, test electrode is inserted to ensure the best location is determined.

During this time, the lightly sedated patient will be woken up to perform simple motor examination such as moving their limbs or talking. In stage 2 once the optimal position of the leads is determined, will proceed with permanent leads and neurostimulator placement.

Recovery with DBS Therapy

Just like any surgery, adequate recovery time is required and you can resume light activities after two to three weeks after surgery but complete recovery may take six to eight weeks. It is advisable to avoid certain physical activities during the first 3 months post-surgery as you have an implant in your body.

You will be scheduled for 1st follow up programming by your Neurologist 2 weeks after your surgery. During your recovery phase, your Neurologist will work with you for program adjustment to your neurostimulator for optimal coverage.

What is Motor Cortex Stimulation (MCS)?

Motor cortex stimulation is a surgical procedure where small electrodes are placed on the precise area of the motor cortex (surface of the brain). The electrodes then connected to a neurostimulator that generate electric pulses and this stimulation ease the pain in selective chronic pain conditions.

Who are Candidates?

Candidates likely to benefit from MCS are the Post-Stroke Pain and Trigeminal Neuralgia. If the standard treatment with medications or other therapies such as injections, nerve blocks and etc failed to manage the symptom, you may be a candidate for MCS.

Components of a Motor Cortex Stimulation

A spinal cord stimulation system consists of the implanted components.

Neurostimulator — Rechargeable or non-rechargeable implanted device (power source) that generates electrical pulses and is usually surgically implanted under the skin of your collarbone

Leads — an Insulated medical lead with a protective coating and an electrode. The electrodes transmit the electrical pulses to the stimulation site from the Neurostimulator