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Deep Brain Stimulation (DBS) involves a neurosurgical procedure for curing movement and affective disorders. It is generally used for treatment of Parkinson's disease and dystonia.
It helps control the brain activity quite effectively and it is one of those neurosurgical procedures that permits blinded studies (in which information about the test is concealed until it is conducted).
Deep Brain Stimulation is generally used for the treatment of the following conditions:
A few days before the therapy, patient is required to undergo several tests, such as electrocardiogram, blood test, chest X-ray, etc. After that, an MRI scan of the brain is conducted to chalk out the sections of the brain where the electrodes will be implanted.
Intake of all non-steroidal anti-inflammatory medicines and activities like smoking, drinking and chewing tobacco are strictly denied as it may lead to bleeding problems.
Deep Brain Stimulation is conducted in 2 parts - Brain Surgery and Chest Wall Surgery.
Brain Surgery - Local anaesthesia and sedatives will be given during this surgery. This is to ensure that you remain awake and the exact section of the brain is stimulated. Brain surgery is done is 6 steps.
Step 1: Fixing Stereotactic Frame
This stage involves fixing a frame onto your head stereotactically using Velcro steps. To reduce the discomfort caused during the procedure, the four pin sites are injected with local anesthesia.
Step 2: CT or MRI Scan
Now an imaging scan is done either with magnetic resonance imaging (MRI) or computerized tomography (CT). A localizing apparatus in the box shape is fixed at the top of the frame. The device displays the markers on the scan that highlight the precise three-dimensional coordinates of the area within the brain.
Step 3: Skull and Skin Incision
Under this stage, the stereotactic head frame will again be fastened onto your head accompanied by small sedation to make the patient feel comfortable during the preliminary skin incision.
Along the incision line, the hair is removed almost an inch wide. Then, using a drill, two burr holes quarter-sized are made on the right and left side of your skull. These holes are created so that electrodes can be easily made to pass through the brain.
Step 4: Insertion of Electrode
An electrode is implanted in the brain using the small hole. Moreover, after the assessment of MRI/ST scan reports, the electrode is inserted based on precise angle and depth inside the brain. A number of tests are conducted to gauge the accuracy of the electrode incision.
Step 5: Stimulation of Brain Cells
After locating the exact nerve cells, the surgeon replaces the incised electrode with a permanent DBS lead/electrode and test stimulation is conducted.
Step 6: Closure
After the surgical team is satisfied with the placement of electrode, a plastic cap is fixed to the burr hole to keep the lead in place. For further attachment with the stimulator and the extension wire, a coil of wire is left beneath the scalp.
Chest Wall Surgery - This procedure is performed 2 to 3 days after the brain surgery.
You will be given general anaesthesia. A pacemaker - like device will be implanted in under your skin in the chest (near collarbone). Wires from electrodes placed in your brain will be connected to this device, and used to send electrical pulses to your brain continously. You will be given a remote using which you can control the device.
The swelling of brain around the electrode tip is a common phenomenon that may lasts from some days to weeks. You will be given antibiotics to reduce / avoid the infection.
After the chest wall surgery, the doctor will activate and program the device implanted in your chest using the remote control. Depending on your condition, you can control the device. You will have to visit your doctor regularly to check if the device is working efficiently.
Deep Brain Stimulation is serious procedure and doctors will weigh benefits against risks before the procedure. Known complications of the procedure are:
This procedure is not necessarily successful for everyone. If it is successful, your symptoms and conditions will improve significantly.