Deep brain stimulation surgery is a specialized type of surgery which is used to treat diseases of brain that has abnormal rhythms like Parkinson’s disease (PD).
Deep brain stimulation is a surgical procedure that involves planting electrodes within specific planned areas of your brain. These electrodes then create a normal rhythm of electrical impulses that regulate the abnormal impulses that your brain generates. The electrical impulses may also affect certain cells and chemicals within the brain. The amount of stimulation that these electrodes generate in deep brain stimulation is controlled by a pacemaker-like device that is placed elsewhere under the skin in your upper chest, collarbone or abdomen. A wire will travel under your skin to connect this device to the electrodes in your brain. Deep brain stimulation blocks electrical signals from the brain which cause tremors, rigidity and involuntary movements.
Deep brain stimulation surgery is considered as a treatment for those patients with Parkinson’s disease (PD) whose symptoms cannot be kept in check by medication.
How does deep brain stimulation surgery work ?
Deep brain stimulation surgery is a type of stereotactic surgery. Stereotactic surgery is a minimally invasive form of surgical intervention that utilizes a three-dimensional coordinate system to locate small targets and permits the accurate positioning of electrodes or probes inside the brain or other organs of our body. This surgery uses mainly three components for its functionality.
- An Electrode: An insulated wire which is implanted in the brain through a small opening in the skull. The target area for implantation of the electrode is pre-determined by a CT or an MRI scan. The targets in the brain are mainly the brain are the thalamus and sub-thalamic nucleus.
- A Neurostimulator: This is also called as an Internal Pulse Generator (IPG) or a battery-operated device which is implanted under the skin either near the collar bone, chest or the abdomen. Its job is to create and transmit electrical impulses via the wires to the electrodes.
- An Extension: An insulator wire which connects the electrode to the neurostimulator.
Different disease states may require different targets and different targets require different lead shapes. Unlike a “single size fits all” technology, this treatment has to be customized individually for each patient.
What is deep brain stimulation surgery used for ?
Deep brain stimulation (DBS) surgery has provided extraordinary benefits for people with a variety of neurologic conditions. Stimulation of a nucleus of the thalamus can dramatically relieve tremor associated with essential tremor or Parkinson’s disease (PD). Similarly, if the subthalamic nucleus is stimulated, bradykinesia, rigidity, tremor and gait (walking) difficulties in people are significantly improved. Bradykinesia basically means slowness of movement and is one of the basic manifestations of Parkinson’s disease.
The neurological conditions that can be treated by deep brain stimulation surgery include the following.
- Essential tremor (a neurological disorder that causes involuntary and rhythmic shaking, that can affect almost any part of your body, but mostly hands).
- Parkinson’s disease (neurodegenerative disorder characterized by inability to control the body movements).
- Dystonia (movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements and abnormal postures).
- Epilepsy (a type of chronic neurologic disorder, the characteristic of which is recurrent, unprovoked seizures).
- Tourette syndrome (a neurodevelopmental disorder that becomes evident in early childhood or adolescence. It is part of the spectrum of Tic Disorders and is characterized by repetitive and involuntary movements and vocalization).
- Chronic pain
- Obsessive compulsive disorder
- Deep brain stimulation surgery is also being studied as a trial treatment for major depression, stroke recovery, addiction and dementia.
This treatment is kept for people who are not able to obtain control of their symptoms with medications.
What is Parkinson’s disease ?
Parkinson’s disease is a neurodegenerative disorder characterized by inability to control the body movements. This neurodegeneration is owed to ceased production of dopamine which is a neurotransmitter produced by the brain and is responsible for bodily movements. Individuals suffering with Parkinson disease are unable to control voluntary movements like walking, standing, facial expressions and may progress on to tremors and stiffness in the advanced stages. Treatment of Parkinson’s disease is started with medications to control the involuntary movements and rigidity. Patients who have been diagnosed with Parkinson’s disease and do not show improvement with medication could be a potential candidate for deep brain stimulation surgery.
How do you know deep brain stimulation surgery is for you ?
If you are experiencing symptoms of dyskinesia (involuntary muscle movements) which are not improving on medications or if the medications are only providing a temporary relief then it is advised to consult a neurologist or a neurosurgeon who would conduct a thorough evaluation of your symptoms along with investigative adjuncts like CT scan and MRI and would then recommend a deep brain stimulation surgery if it suits your best interests.
Is there any contraindication for deep brain stimulation surgery ?
The procedure is not recommended in individuals who are suffering from dementia (memory loss) as it may worsen the condition. It also does not slow down the neurodegenerative process of Parkinson’s Disease.
Is age a factor in determination of the suitability of deep brain stimulation surgery ?
No, age is not a determinant. A thorough evaluation of your symptoms along with your previous medical history would suggest if you are a suitable candidate for Deep brain stimulation surgery.
Does deep brain stimulation surgery require anesthesia ?
The patient is usually awake during the procedure and small quantity of anesthetics may be administered in certain sensitive areas which may lead to discomfort or pain. The reason behind keeping the patient awake is to assess the response when the electrode implanted is stimulated.
Who performs deep brain stimulation surgery ?
Deep brain stimulation is a specialized surgery which is performed by a team of experts including neurologists and neurosurgeons who are trained to perform the procedure.
How do you prepare for deep brain stimulation surgery ?
- Decide for the procedure: Even if you might be eligible for deep brain stimulation, you and your doctors must carefully weigh the risks and potential benefits of the procedure as it is a serious and potentially risky procedure. Weigh the pros and cons with your neurosurgeon.
- Prepare for the surgery: Before surgery, you will need medical tests to make sure that deep brain stimulation is a safe and appropriate option for you. You will be asked to undergo brain-imaging studies like MRI, before the surgery, to chart the areas of your brain in order to implant the electrodes.
What you can expect during deep brain stimulation surgery ?
- Electrode placement in brain surgery: The surgeons will first do the brain surgery. Your surgical team fits you with a customized head frame to keep your head immobile during the procedure (known as a stereotactic head frame). Then, they will use magnetic resonance imaging (MRI) to map your brain and identify the area in your brain where they will place the electrodes. You will be given a local anesthetic to anesthetize your scalp before surgery. However, you won’t require an anesthetic in your brain itself as the brain has no pain receptors. Your surgeon implants a thin wire lead with a number of electrodes at the tips into a precise area of your brain. Mostly, it is required that you remain awake and attentive during the procedure so that your neurologist can communicate with you to make sure the correct areas of your brain are being stimulated. Your responses during the surgery will help your health care team put the lead in the precise place while diminishing side effects. During this surgery, both the neurologist and surgeon cautiously monitor your brain to make certain accurate electrode placement. This step takes around 3 to 5 hours to do.
- Chest wall surgery: During the second part of the surgery, ensuing on the same day or at a later period, the surgeon implants the part of the device that contains the batteries (pulse generator) under the skin in your chest, near your collarbone or in the abdomen.General anesthesia is used during this procedure. Extension wires are connected to the brain electrodes which are then placed under your skin and guided down to the battery-operated pulse generator. This generator is then programmed to fire continuous electrical pulses to your brain. You will be given control of the generator with the help of a special remote control. The device is not switched on right away at the time of the procedure. This step takes about 45 minutes to do.In the usual sequence, patients often have these surgeries two to three days apart.
What happens after deep brain stimulation surgery ?
Post Anesthetic Care Unit (PACU)
- When this surgery is over, you will be admitted to the Post Anesthetic Care Unit (PACU) for 1 to 3 hours to recover.
- The nurses will check your vital stats like blood pressure, pulse, temperature and breathing frequently, as you wake up. If you have pain, nausea, or post-operative symptoms they will give you medicines to help them.
- You will have an intravenous line and may have an oxygen mask on.
- There will be a dressing covering the incision both on your head and chest.
- When you are ready, you will be taken to the Neurosurgery Unit.
Neurosurgery Unit
- Once in the Neurosurgery Unit, your health care team monitors your recovery.
- You may have certain postoperative symptoms like a headache, pain in your incisions and nausea. This will gradually get better. The nurses can administer you medicines for the pain and nausea if you require them.
- As the day draws on, you can start both drinking and eating by evening.
- Later in the day or the next day, the nurses help you get out of bed and walk. You may feel a little dizzy, so it is imperative that you have someone with you the first few times you get out of bed.
- You will have to undergo another MRI to check the electrode position.
What post operative care needs to be followed ?
The patient is usually discharged from the hospital after two days of the procedure. Post operative instructions include keeping the surgical site dry and covered in bandage which should be changed at least once a day. The surgical staples or stitches if used any need to be removed on the next visit to the consultant mostly after 7-10 days of the procedure. The consulting surgeon might also ask you to restrict yourself from any strenuous exercise like jogging, swimming or any heavy house work. The restoration of all activities can be achieved usually 6 weeks after the procedure or as suggested by your doctor. Some patients also required to take medication after the deep brain stimulation procedure which can be clarified with your consultant surgeon. You will have follow-up visits within a few weeks and then maybe at 6-8 weeks of the procedure to start the device and then check the performing of the device.
What is to be expected after a deep brain stimulation surgery ?
Once a few weeks have passed after surgery, the pulse generator in your chest will be activated in your doctor’s office. The doctor can with no trouble program your pulse generator using a special remote control from outside your body. The amount of stimulation needed is tailored for your condition. Stimulation may be steady, all through the day, or your doctor may then advise you to turn your pulse generator off at night and back on in the morning, based on your condition. This stimulation can be turned on and off with a special remote control that you will be taking home with you. In certain cases, your doctor may program the pulse generator to let you make slight adjustments at home.
How long does the battery of the neurostimulator last ?
The battery lasts for around 3 to 5 years. The battery life of your generator will vary with both the usage and settings. Once the battery is low, you may begin to become aware of a return of the symptoms. When the battery needs replacement, your surgeon will restore the generator during an outpatient procedure. You can return home the same day you have this surgery.
What are the results of deep brain stimulation surgery ?
Deep brain stimulation is an advanced surgical technique which causes minimal damage to the brain tissue and helps in controlling symptoms of Parkinson disease such as tremor, rigidity, stiffness and difficulty in doing daily activities. Though the procedure requires most of the patients to continue medication after the procedure the success rates of the procedure are well documented in literature. The principle of deep brain stimulation is based on blocking the electrical signals which produce involuntary movements but it necessarily does not slow the progression of neurodegeneration. Deep brain stimulation isn’t successful for everyone. Hence an appropriate consultation with a specialist is primarily essential for tailoring the most suitable treatment which offers the best prognosis.
What are the potential complications related to deep brain stimulation surgery ?
Deep brain stimulation is a procedure which causes minimal or no damage to the brain tissue. Hence, the complications related to the procedures are greatly reduced. The rare complications of the surgery may include the following.
- Bleeding or infection at the surgical site
- Persistent headaches
- Blurring or loss of vision
- Heart problems
- Seizures
- Constant fever
- Breathing problems
- Nausea
Side effects that can be caused by deep brain stimulation may include the following.
- Seizure
- Infection
- Headache
- Confusion
- Stroke
- Hardware complications, such as an eroded lead wire or the wearing out of battery’s life
- Pain, swelling and inflammation at the implantation site
The device will be turned on and the process of finding the best settings for you begins, after a few weeks have passed. Some settings can cause side effects, but these often get better with adjustments of your device. You may want to get a Medic Alert bracelet stating that you have a DBS system. This will alert medical staff that you have a DBS system in case of an emergency.
What care do you have to take to stay safe after the process of deep brain stimulation surgery ?
You must protect yourself and stay safe after getting a Deep Brain Stimulation system. These are general rules for safety when you have a deep brain stimulation system.
- It is better to avoid a body MRI. You can have a brain MRI. Inform your health care providers that you have a Deep Brain Stimulation system so they can take measures to keep you safe.
- Avoid diathermy treatments (or heat therapy).
- Do not put direct heat on any part of the Deep Brain Stimulation system. This could cause damage to it and have an effect on your health.
Will you be able to use electronic devices after deep brain stimulation surgery ?
Home appliances, phones, computers and other gadgets do not interfere with the functionality of the device implanted during the deep brain stimulators. But metal detectors at security checks in the airport, stations can affect the neurostimulator to switch off. Hence it is advised to carry an identification which states that an electronic implant is implanted to avoid any further complications as well.
What are the advances in the field of deep brain stimulation surgery ?
The subthalamic nucleus approach for deep brain stimulation is a recent advancement and is considered an advanced procedure in the treatment of Parkinson disease. The symptoms are controlled and the results are good. Consultation with the doctor to understand the best suited treatment affects the total outcome of the treatment.
How to find and reach neurosurgeons for deep brain stimulation surgery ?
Now you can find and reach neurosurgeons from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple neurosurgeons, get cost estimates for deep brain stimulation surgery from different hospitals, compare things and then choose a neurosurgeon for deep brain stimulation surgery.
Find, reach and choose a neurosurgeon for deep brain stimulation surgery on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
