Deep brain stimulation (DBS) is a surgical procedure in which the electrodes are implanted into the brain to deliver electrical impulses. These impulses aim to block or change the abnormal activity that cause associated symptoms.
A Deep brain stimulation system consist of three parts that are implanted by the surgeon inside the body:
- Neurostimulator – a battery-powered pacemaker device that produces electric pulses. The device is placed under the skin of the chest, just below the collarbone or in the abdomen.
- Lead – a coated wire attached to a number of electrodes at the tip. These electrodes deliver electric pulses to the brain tissue. The leads are placed inside the brain and connected to an extension wire via a small hole in the skull.
- Extension – an insulated wire that is connects the lead to the neurostimulator. It is placed under the skin, running from the scalp, behind the ear, down the neck, and to the chest.
The handheld controller is then used to turn the DBS system on and off. The doctor will program the stimulator settings using a wireless device and adjust the stimulation settings as a patient’s condition changes over time. Unlike other procedures, such as pallidotomy and thalamotomy, Deep brain stimulation (DBS) surgery does not cause damage to the brain tissue.
For the brain surgery portion, the neurosurgery team first use magnetic resonance imaging (MRI) to map the brain and identify the area in the brain where the electrodes have to be placed.
Surgery for implanting DBS device may be done under general anaesthesia or using a local anaesthetic to numb the scalp before the procedure as an anaesthetic in the brain itself is not required because the brain has no pain receptors.
The surgeon will implant a thin wire lead with a number of electrodes at the tips into the specific area of the brain. The wire will run under the skin to a pulse generator or neurostimulator that is implanted near the collarbone.
In the second part of the surgery, the surgeon will implant the part of the device containing batteries under the skin in the chest, near the collarbone. It is done under general anaesthesia.
Deep brain stimulation can be used to treat many of the symptoms that are caused by the following neurological and movement disorders:
Parkinson’s disease: The symptoms such as tremor, rigidity, and slowness of movement are related to Parkinson’s disease. These are caused due to the death of dopamine-producing nerve cells that are responsible for transferring messages across the body to control body movement.
Essential tremor: The patient suffers from involuntary rhythmic tremors of the hands and arms, occurring both during rest and while making purposeful movement. It may also affect some patient’s head in a “no-no” motion.
Dystonia: It involves having involuntary movements and a prolonged contraction of muscles, causing twisting or writhing body motions along with tremors and abnormal posture. It can affect the entire body, or be limited to an isolated area only. Patients may suppress the spasms by using “sensory tricks,” such as touching the face, eyebrows, or hands.
DBS surgery may not be an option if a person has severe untreated depression, advanced level dementia, or they have symptoms that are not typical in case of Parkinson’s disease.
Deep brain stimulation is also currently being studied as a potential treatment for other medical conditions, including:
- Major depression
- Multiple sclerosis
- Chronic pain
- Traumatic brain injury
- Cluster headache
- Huntington’s disease
- Stroke recovery
- Tourette syndrome
DBS surgery has become popular amongst patients Parkinson’s and other diseases around the world. Numerous people travel to India for this procedure due to various reasons, such as low cost, advanced facilities, experienced surgeons and excellent patient care services.
Deep brain stimulation cost in India is very reasonable in comparison to various other countries, especially in the west. Indian hospitals offer cost-effective medical packages for patients travelling from abroad for their treatment.
DBS Surgery Advantages
- Deep brain stimulation can be performed on both sides of the brain in order to control symptoms that affect both sides of the body.
- The effects of DBS are reversible and can be customized according to a patient’s clinical condition.
- Stimulation settings and impulses can be adjusted to reduce the chances of potential side effects and improve efficacy of the system over time.
- The device can be used to provide continuous control of the symptom 24 hours a day.
- Patients who have DBS implanted still remain potential candidates for other treatment options such as stem cell therapy, gene therapy or others when they become available.
- This procedure has been proven to be more effective and safer than ablative surgical procedures, in which the tissues are removed
- Long-term complications are less than that in case of traditional surgery as conventional surgery approaches involve destroying small parts of the brain, whereas DBS does not cause this damage
- Stimulator can be easily programmed and managed
- The device can be removed when required – is reversible
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