Deep Brain Stimulation Procedure
Overview
Deep brain stimulation (DBS) is a neuromodulation therapy that uses electrical pulses to adjust brain activity. Surgeons place electrodes in specific brain regions like the subthalamic nucleus (STN), internal globus pallidus (GPi), or ventral intermediate nucleus (VIM).
These electrodes connect through a thin wire to a neurostimulator, a small device similar to a pacemaker, which surgeons implant under the skin in the upper chest. DBS therapy helps manage neurological and psychiatric conditions such as Parkinson’s disease, essential tremor, dystonia, epilepsy, Tourette syndrome, and obsessive-compulsive disorder.
The electrical stimulation does not damage brain tissue but changes brain signals. This approach offers another method when medicines or other treatments are not effective.
Reasons for Deep Brain Stimulation
Doctors use deep brain stimulation when drugs do not control symptoms enough for people living with certain health problems. It often helps those with movement issues such as Parkinson’s disease, essential tremor, or dystonia.
It can also support people with epilepsy, especially if seizures continue despite other treatments. Doctors sometimes suggest this procedure for psychiatric conditions like depression and obsessive-compulsive disorder. The main symptoms it targets include:
- Tremor
- Stiffness
- Slowed movement
- Uncontrolled seizures
- Levodopa-responsive parkinsonian tremor
Doctors may consider deep brain stimulation as an adjunctive therapy when standard treatments are not enough.
Potential Health Risks
Dangers Linked to the Procedure
Deep brain stimulation surgery always involves some possible complications. During surgery, doctors make small holes in the skull and place wires deep in the brain. They also insert a device below the skin in the chest to power the system.
| Possible Complication | Details |
|---|---|
| Infection | May develop at the surgery site. |
| Brain bleeding | Higher risk of stroke or brain damage. |
| Stroke | Due to bleeding or other problems. |
| Irregular heartbeat, trouble breathing | Linked to anesthesia or procedure. |
| Seizure | Sometimes occurs during or after surgery. |
| Wire misplacement | Leads may be placed in the wrong spot. |
| Nausea | Often due to general anesthesia. |
Surgical risks may also encompass pain or swelling at the incision site. There is also the chance of issues with the device itself, such as wire or hardware problems.
After-Procedure Side Effects
After surgery, some side effects might appear. Common issues are headaches, pain, and swelling where the device was placed. Some people experience confusion, difficulty focusing, and in rare cases, seizures. Hardware complications, including eroded wires, can also happen.
List of Possible After-Surgery Symptoms
- Temporary pain or swelling
- Headache
- Infection
- Confusion
- Trouble concentrating
- Stroke
- Seizures
- Problems with the device or wires
Rarely, deep brain stimulation affects movement skills such as swimming. People with this device should avoid treatments like diathermy, electroconvulsive therapy, and transcranial magnetic stimulation (TMS).
Side Effects Linked to Brain Stimulation
After doctors activate the device, stimulation settings may cause other problems. Sensations like numbness, tingling, or tight muscles in the face or arms can happen. Balance issues, speech difficulties, and headaches may also occur. Some people notice mood changes, such as anger, depression, or mania, and changes in vision like double vision.
- Physical: Muscle tightening, numbness, dizziness
- Speech/Balance: Trouble talking, difficulty balancing
- Mental/Emotional: Mood swings, irritability
- Vision: Double vision
- General: Headache
Patients should discuss any severe or long-lasting side effects with a healthcare professional.
Getting Ready for the Procedure
People should have a careful talk with their neurologist and other doctors about the risks and benefits of deep brain stimulation. Making a table that lists possible side effects, safety steps, and other treatment options can help with the decision. It is also wise to learn about any medication changes needed before the procedure.
Doctors usually order tests such as MRI or CT scans to decide if the surgery is safe. These images guide where electrodes will be placed. Patients must follow detailed instructions about which medicines to take or pause, and should review MRI guidelines about full body MR conditional or image-ready MRI technology.
What to Anticipate
Steps Taken During Surgery
The surgical process for deep brain stimulation starts with the placement of a specialized head frame. This frame keeps the head steady for precise electrode positioning. Advanced imaging methods, such as MRI or CT scans, help neurosurgeons plan exactly where in the brain to insert the electrodes.
In most cases, the patient stays awake during the brain surgery. Doctors use a local anesthetic to numb the scalp, allowing the person to stay comfortable without feeling pain. The neurosurgeon and the team can check in real time how stimulation affects movement or other symptoms. For some, doctors use general anesthesia instead.
Surgeons insert a thin wire, known as a lead, with electrodes into a targeted spot in the brain. Sometimes, the surgeon places one lead on each side of the brain for bilateral stimulation. In cases where only one side needs treatment, unilateral thalamic stimulation may be chosen.
During the operation, the team may use directional leads to focus stimulation more precisely, which can reduce side effects. A team, usually including a neurosurgeon and a neurologist, monitors lead placement carefully at each stage. They make adjustments as needed to get the best result.
After the brain portion, the next step involves placing the pulse generator. The generator is a small device with a battery implanted under the skin in the chest, typically near the collarbone. Surgeons tunnel wires from the brain electrodes under the skin and connect them to this battery-powered device. For this part, doctors most often use general anesthesia.
| Step | Who is involved | Main purpose |
|---|---|---|
| Head frame & imaging | Neurosurgeon, radiology | Keep head still, plan the surgery |
| Electrode lead placement | Neurosurgeon, neurologist | Insert wires for targeted stimulation |
| Chest device implantation | Neurosurgeon | Install battery-powered pulse generator |
| Lead placement monitoring | Neurosurgeon, neurologist | Check and adjust for best effect |
Recovery and What Happens Next
After surgery, the next important stage is programming the pulse generator. This usually happens a few weeks after the operation, often in a clinic using a remote control. The neurosurgeon or another expert customizes the settings for each patient. These stimulator settings control how strong and how often the electrical signals are sent to the brain.
Getting the settings just right can take several visits. Sometimes it takes 4 to 6 months to find the most effective arrangement. Signals may be delivered constantly throughout the day and night, or the person may be advised to turn the device off during sleep with a provided remote.
The remote control allows the patient to manage certain features at home, depending on what is allowed for their case. Battery life for the generator depends on settings and use. Eventually, the battery will need to be replaced, but this is done with a simple outpatient surgical procedure. Here’s a checklist of what to expect after the operation:
- Several appointments to tailor the settings.
- Time needed to reach the best symptom control.
- Ability to turn the device on or off as advised.
- Return to the clinic for a battery replacement when needed.
If questions or side effects arise at any stage, the neurosurgery team remains involved to provide further help and adjustments.
Findings
Deep brain stimulation (DBS) can lead to meaningful improvements in symptom control and quality of life, though some symptoms might not disappear completely. Many people continue to need medication after DBS. Review of data shows:
| Outcome | Details |
|---|---|
| Symptom Control | Better movement and less tremor in many cases. |
| Quality of Life | Notable improvements for most recipients. |
| Functional Disability | Improvement depends on individual response. |
