Deep brain stimulation information

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What is deep brain stimulation?

Deep brain stimulation is a surgical intervention used to treat movement disorders such as dystonia, essential tremor and Parkinson’s disease when the regimen of existing medications and the various rehabilitation strategies become less effective in managing symptoms. This is a relatively new surgical procedure that received approval from the Food and Drug Administration to treat essential tremor and tremor in Parkinson’s disease in July 1997 and for advanced motor symptoms of Parkinson's disease in January 2002. It is currently approved for the treatment of dystonia through a humanitarian device exemption.

The subthalamic nucleus (STN), the globus pallidus (GPi) and the thalamus are three locations in the brain that are targeted in the deep brain stimulation (DBS) procedure for the treatment of movement disorders. DBS administers a well-controlled electrical current into the target area(s). This electrical current functions as an "off switch" by disrupting abnormal brain signals responsible for the abnormal pysical movement. This disruption helps restore more normal activity in the brain, enabling more controlled movement.

Brain anatomy
DBS does not involve destruction of brain tissue and its effects are reversible and adjustable. It is not preferred over the thalamotomy or pallidotomy, two surgical techniques that involve the actual destruction of the brain cells that are "misfiring." Electrical impulses which are generated from an implanted battery, pass through the lead and into the target area. This entire system is implanted under the skin.

The effectiveness of the DBS procedure depends on accurate placement of the brain lead(s) or wire(s) and therefore requires special expertise. The evaluation and surgical procedure are conducted at VCU using a team approach involving neurosurgery, neurology, neuropsychology and a trained nursing staff. The target areas or nuclei are quite small and special imaging techniques and guidance devices are used to help position the leads. The patient is awake during portions of the surgery and becomes an important member of the team. The patient also helps in determining whether beneficial effects occur when the stimulation is applied during surgery.

DBS can be an effective treatment in those hard-to-treat patients who meet specific criteria. Unforunately, there is a 1-3% risk that the brain will be injured during the DBS procedure. As a result of this damage, patients may experience loss of speech, paralysis, coma or even death - usually caused by bleeding in the brain. There is an additional 5% risk of infection usually requiring the removal of the device.

DBS surgery can be time consuming, usually lasting three to four hours per side of the brain being operated on. The most common complaints from patients include back and neck pain and fatigue.