Deep Brain Stimulation (DBS)

DBS is used to treat various neurological and psychiatric conditions, including:

• Essential tremor: one of the most common types of adult-onset movement disorder that is characterized by trembling or shaking of the hands but can also affect the head, trunks, voice, and legs.
• Parkinson’s disease: a progressive neurological disorder affecting movement, balance, and coordination.
• Dystonia: a movement disorder characterized by muscle contractions that cause abnormal postures and movements.
• Tourette syndrome: a neurodevelopmental disorder characterised by repetitive, involuntary movements and vocalizations called tics. Symptoms can involve a wide range of movements, such as eye blinking, facial grimacing, shoulder shrugging, and jerking.
• Epilepsy: a neurological disorder that causes recurrent, unprovoked seizures due to abnormal electrical activity in the brain.
• Obsessive-compulsive disorder: an anxiety disorder in which people have intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform.

Although not without risks, DBS is safe and highly effective in properly selected patients. It is typically recommended for individuals whose neurological conditions have not responded well to medications or who cannot tolerate high doses due to side effects.

• Reduction of Symptoms

Treatment with DBS results in improved functioning and a reduced need for medications in some cases.

• Non-Invasive

Unlike ablative surgery, DBS does not remove or destroy brain tissue. This can lead to a faster recovery time and reduced risk of complications.

• Customizable

Although DBS works by providing continuous stimulation, it can also be adjusted through remote control, allowing patients to turn it on and off as needed.

• Long-lasting Results

DBS has been shown to produce long-lasting results in reducing the symptoms of various disorders. A recent study revealed that DBS remains effective after 15 years in patients with Parkinson’s disease.

• Reversible

If a patient experiences adverse effects, the DBS program can be adjusted to avoid them. If the treatment is no longer needed, the electrodes and pulse generator can be removed without causing permanent damage.

Like any surgical procedure, there are potential risks associated with deep brain stimulation. However, most are mild and temporary. More serious complications, such as infection or stroke, may occur in rare cases. These can be prevented by proper pre-procedure screening and careful monitoring during the recovery period.

Risks and side effects of DBS placement

• Dizziness
• Headaches
• Worsening neurological condition
• Problems in concentrating
• Loss of balance
• Speech or vision problems
• Infection
• Pain or swelling
• Bleeding in the brain

Additionally, patients should monitor battery life closely since IPGs traditionally require replacement every three years due to their limited capacity.

• Before Surgery

  You will undergo a thorough evaluation by a DBS-experienced neurologist to determine if DBS is right for you. The movement disorders neurologist will request memory and cognitive tests to assess your thinking abilities and a psychiatric evaluation to determine if any underlying conditions need to be addressed before surgery. Your neurologist will guide you in preparing for the procedure, which may include changes to your diet or medications. The insertion of the components requires one or two separate surgeries.

  During Surgery

  DBS is performed while the patient is awake or under general anesthesia and involves a hospital stay of several days. The neurosurgeon will make a small incision in the scalp and drill a small hole in the skull to insert electrodes into the targeted area of the brain. The neurologist and the neurosurgeon will use clinical, radiological and electrophysiological evaluations to determine the best location of the DBS lead in the brain. The electrodes will be connected to a wire that runs under the skin to a pulse generator implanted in the chest. Once the electrodes are in place, the incisions will be closed, and the team will take you to a recovery room for observation.

  After Surgery

  You may need pain medication to help manage any discomfort in the incision areas.

  After the procedure, you will return for a follow-up appointment to have the pulse generator activated. The generator sends electrical impulses to the electrodes to stimulate the brain and alleviate your symptoms. You will have several follow-up appointments with your neurologist to monitor your progress and adjust the stimulation if needed.

  Results

  Several studies suggest that DBS can be an effective treatment for Parkinson’s and other movement disorders. Patients experience sustained improvements of motor control and quality of life. A retrospective analysis revealed that DBS provides durable symptomatic relief and allows many individuals to maintain activites of day living (ADLs) over long-term follow-up greater than 10 years. In another randomized trial, patients saw a 40% reduction in seizure frequency after 3 months of DBS and 70% after 5 years.