Deep Brain Stimulation

Deep Brain Stimulation

What is Deep Brain Stimulation?

Deep Brain Stimulation (DBS) is a neurosurgical procedure in which one or more small electrodes are implanted in a specific area of the brain depending upon the symptoms being treated. The electrodes send electrical stimulation that regulate the abnormal activity which causes the symptoms. The amount of stimulation to be delivered by the electrode is controlled by a device placed under the skin of the chest.

Why is it done?

The Deep brain stimulation procedure is performed to treat patients with movement disorders such as Parkinson’s disease, Essential tremor, Dystonia, Epilepsy, Obsessive-compulsive disorder etc. whose symptoms cannot be controlled through medication or other treatment.

What happens during the procedure?

Deep Brain Stimulation (DBS) surgery is performed in two stages. Both stages can be done on the same day or the next day, depending upon your condition.

First stage: The first stage of DBS involves brain surgery which is mostly performed under local anaesthesia so that you are awake and alert. Before surgery, your head will be fixed in a special frame to keep it still during the procedure. Through small burr holes made in your skull, a thin wire lead with electrodes at the end is implanted into the targeted area where abnormal activity occurs. This targeted area is identified with the help of MRI or CT scan. A connecting wire runs under the skin to a battery-operated pulse generator which is implanted near the collarbone in the second stage of the surgery.

Second stage: In the second stage, chest wall surgery is performed under general anaesthesia either on the same day or next day. A pacemaker-like device (pulse generator) will be placed under the skin in the upper chest area near collarbone. The electrodes are connected to this pulse generator with wire passing under the skin placed during the first stage of surgery.

Once the surgery is over, a plastic cap is placed over the burr hole to hold the lead in place and incision site is closed.

What happens after the procedure?

Post-surgery, you will be hospitalised for 1 or 2 days and discharge will be planned based on your recovery.

External Programming generally begins one or two weeks after surgery and is mostly done on an out-patient basis. The device will be programmed to send continuous electrical pulses to your brain, modifying the abnormal activity in the targeted area of the brain that is causing symptoms. Regular scheduled follow-up visits will be required to ensure that the system is working properly or to adjust the stimulation or check the battery life of the device.

FAQs

What components does DBS system consist?

• A lead: It is a thin wire with an electrode at the end. This will be implanted in the target area of your brain.
• A pulse generator: It is a pacemaker-like device that sits under the skin near your collarbone. A pulse generator creates the electrical pulses.
• An extension lead: The extension wire travels under the skin and is connected with the lead to the pulse generator. An extension lead carries electrical pulses from the device to the leads implanted in your brain.

Once activated, the pulse generator will send out electrical signals that helps in modifying the abnormal activity in the targeted area of the brain that is causing symptoms. The device runs on a battery.

Am I a suitable candidate for DBS surgery?

• Your symptoms are not getting controlled despite of appropriate dose of medications.
• Your symptoms are significantly affecting your quality of life.
• For considering you fit for DBS, you will be extensively evaluated by our multidisciplinary team of specialists. The evaluation will include MRI, clinical and neurological investigations, etc.

What are the advantages of DBS surgery?

• DBS does not cause any brain damage.
• DBS provide continuous symptom control throughout the day.
• DBS makes daily routine activities like writing clearly easier.
• DBS reduces medicine intake.
• The electrical stimulation can be adjusted as per patient’s requirement.

Will DBS cure my diseases for which I will be using it?

DBS does not cure your disease. However, there will be a significant improvement in the symptoms which will further improve your quality of life.

Post deep brain stimulation surgery, do I need to limit my activities?

• For 2 weeks, you should not engage in any light activities including house-hold chores.
• For 4 – 6 weeks, you should not engage in heavy activities such as jogging, swimming.
• Don’t raise your arms above your shoulders or over bend or stretch your neck till further advice from doctor.
• Don’t lift heavy things till further advice from doctor.
• You may return to work within 4 to 6 weeks, depending upon the work you do.