Deep Brain Stimulation

What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a neurosurgical procedure performed to control and manage abnormal brain activity symptoms associated with a number of neurological conditions. The procedure involves placement of electrodes into the targeted areas of the brain. These electrodes create electrical signals that regulate abnormal brain activity. DBS works similar to a pacemaker, conveying electrical impulses to the brain instead of the heart.

Deep brain stimulation can help to decrease symptoms of stiffness, tremors, slowness, psychiatric issues, and walking problems connected with neurological disorders such as dystonia, epilepsy, Parkinson's disease, obsessive-compulsive disorder, and essential tremor. Successful treatment with DBS enables patients to potentially decrease their dependency on medications and improve their overall quality of life.

Components of a Deep Brain Stimulation Device

A deep brain stimulation system consists of the following parts:

A thin insulated wire called an electrode or a lead that is placed into a specific area of the brain
A neurostimulator, a pulse generator or a pacemaker-like device, that produces electrical impulses
An insulated extension wire that connects the electrode to the neurostimulator
A remote control device to switch the device on and off and adjust the device’s impulses as needed

Indications for Deep Brain Stimulation

Deep brain stimulation is mainly indicated for the treatment of symptoms associated with neurological disorders. DBS is typically employed for patients who have:

Symptoms that are not well managed or controlled despite using medications
Side effects from medications that cannot be tolerated
Symptoms that have significantly reduced the quality of life
Severe dyskinesias and motor fluctuations when medication wears off or even after medication adjustments
Failed conservative treatment measures such as physical, occupational, and speech therapies

Preparation for Deep Brain Stimulation Implantation

Pre-procedure preparation for deep brain stimulation implantation will involve the following steps:

A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
You will be asked if you have allergies to medications, anesthesia, or latex.
You should inform your doctor of any medications, vitamins, or supplements that you are taking.
You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
You should refrain from alcohol or tobacco at least a week before and two weeks after surgery.
You should not consume any solids or liquids at least 8 hours prior to surgery.
You will be instructed to shower with an antibacterial soap the morning of surgery to help lower your risk of infection after surgery.
Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Deep Brain Stimulation Implantation

Deep brain stimulation surgery is performed as a two-stage procedure and involves implantation of the lead or electrode in the first phase and placement of the neurostimulator in the second phase, approximately a week after the lead implantation surgery. In general, the surgery involves the following process:

A small section of the head where a surgical cut is planned is shaved.
Local anesthesia is administered to the area for placement of a special head frame that holds your head firmly in place throughout the procedure.
Your surgeon makes a small cut on the shaved skull and drills a small hole in the skull to implant the lead into the brain under the guidance of live MRI/CT imaging.
The incision in the skull is closed with sutures and an adhesive bandage is applied.

For the second part of the surgery:

An additional cut is made in the upper chest (collar bone) area under local anesthesia to implant the pulse generator (neurostimulator) under the skin.
An extension wire connecting the lead to the neurostimulator is passed below the skin of the head, neck, and shoulder.
Accurate placement of the electrode is confirmed with live imaging, and electrical stimulation is initiated through the electrode to ensure that the device is functioning correctly.
Once your physician activates the pulse generator, it continuously conveys electrical signals to the target sites in the brain, altering the abnormal activity in that site of the brain that is triggering symptoms.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after deep brain stimulation will involve the following steps:

You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
Most patients can go home the same day of the surgery.
Your device will be calibrated to the appropriate settings before leaving.
You may experience pain, inflammation, and discomfort in the operated area. Medications are provided as needed.
Application of cold and heat therapy on the operated area may be recommended to reduce inflammation and pain.
Instructions on surgical site care and bathing will be provided.
A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Deep brain stimulation is a relatively safe procedure; however, as with any surgery, some risks and complications may occur.
General risks of any surgery include:

Infection
Blood clots
Blood loss
Anesthetic reactions

Risks and complications specific to DBS include:

Persistent pain at the implant site
Device malfunction
Tingling sensation in the limbs or face
Headache
A feeling of muscle pulling
Vision or speech issues
Loss of balance
Low risk (1%) of hemorrhage in the brain, including stroke