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Neurosciences

Deep Brain Stimulation


What is Deep Brain Stimulation (DBS)?

DeepBrainStimulation_500When medication is ineffective, severe movement disorders may require surgery. One type of surgery is deep brain stimulation (DBS), where a battery-operated medical device (neurostimulator) is implanted to deliver electrical stimulation to areas of the brain that control movement. The electrical charge blocks nerve signals that trigger abnormal movement.

In DBS, an electrode (lead) is inserted through a small incision in the skull and is implanted in the targeted area of the brain. An insulated wire (extension) is then passed under the skin in the head, neck, and shoulder, connecting the lead to the neurostimulator, which is surgically implanted in the chest or upper abdomen.

 

How does DBS work?

The DBS treatment may be used on one or both sides of the brain based on the symptoms. A DBS System consists of an electrode, a lead extender, and a neurostimulator. During DBS surgery, the electrode is inserted into the brain through a small opening in the skull. It is attached under the skin via a lead extender to a neurostimulator placed in the chest just below the collarbone. All parts of the DBS system are below the skin. The neurostimulator is similar to a heart pacemaker, and allows for electrical stimulation of specific brain areas involved in movement disorders.

 

What symptoms can DBS improve?

The goal of DBS is improved control of movement or other symptoms. Note that DBS is not a cure for any disease. The primary goal of the DBS surgery is to help control the symptoms and provide you with a better quality of life.

 

What are the advantages of DBS compared to other surgical techniques?

Previous surgical approaches to movement disorders were irreversible and involved destruction of brain tissue. In contrast, DBS is reversible because the the DBS System can be removed. DBS also allows for greater flexibility since the neurostimulator can be adjusted.

 

How do I prepare in the days leading up to surgery?

  • Discontinue taking any blood thinners such as Aspirin, Excedrin®, Ibuprofen, Aleve®, Advil®, and Motrin® 14 days before your surgery date.
  • Discontinue taking vitamins and herbal supplements 7 days before your surgery.
  • Shampoo and bathe with an antibacterial soap the night before and the morning of surgery to lessen the risk of infection.
  • Do not eat or drink after midnight. You may drink only clear liquids up to four hours before the surgery. Clear liquids can include water, soda, coffee and tea (no creamer), clear broths, juices without pulp or solid material (apple juice), and popsicles.
  • Take only medicines that are approved in your pre-surgery visit on the morning of surgery. If you are on blood pressure medicine, be sure to talk to your surgeon about those medications.

 

What are the risks?

How do I prepare in the days leading up to surgery? Am I a good candidate for DBS surgery?

The following conditions are a good guide:

  • You have already tried a reasonable course of medications, as determined by a neurologist.
  • You are significantly disabled by your disease.
  • You are in reasonably good health.
  • You can take part in the programming of the device once implanted. (Give feedback during programming sessions & attend clinic visits.)
  • You have an adequate support network of family and friends.

The most serious risk is bleeding into the brain, causing stroke. Less than 1% of patients experience a stroke. The effects of a stroke can include paralysis, loss of speech, coma, or even death. There is also some chance (10%) of less serious complications.These may include infection, malfunction of the stimulator, and movement of the electrode or neurostimulator. Any of these problems may require removal of part or all of the DBS system. 

 

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