What is Deep Brain Stimulation?
Deep Brain Stimulation (DBS) uses a surgically implanted medical device, similar to a cardiac pacemaker, to deliver carefully controlled electrical stimulation the specific structures that control movement and muscle function. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications.
This stimulation can offer relief from tremors, rigidity, slow movement, stiffness and balance problems, as well as essential tremor, a common neurological movement disorder. The stimulation can be adjusted as a patient’s condition changes over time.
Before DBS Treatment
Before the treatment, a neurosurgeon uses magnetic resonance imaging (MRI) or computed tomography (CT) scanning to identify and locate the exact target within the brain where electrical nerve signals generate the PD symptoms. Some surgeons may use microelectrode recording—which involves a small wire that monitors the activity of nerve cells in the target area—to more specifically identify the precise brain target that will be stimulated. Generally, these targets are the thalamus, subthalamic nucleus, and globus pallidus.
How DBS Treatment Works
During a DBS treatment, a craniotomy is performed to create a small opening in the skull, and a thin, insulated wire - called a “lead”, or an “electrode” - is inserted through the opening so that its tip is positioned within the targeted area of the brain.
The neurostimulator, about the size of a stopwatch, is the third component and is usually implanted under the skin near the collarbone. In some cases it may be implanted lower in the chest or under the skin over the abdomen.
A longer insulated wire called the “extension” is then passed under the skin of the head, neck, and shoulder, connecting the lead to the neurostimulator.
a battery-operated medical device called a neurostimulator
Once the system is in place, electrical impulses are sent from the neurostimulator up along the extension wire and the lead and into the brain. These impulses interfere with the electrical signals that cause PD symptoms.
Unlike previous surgeries for PD, DBS does not damage healthy brain tissue by destroying nerve cells. Instead the Parkinson’s Disease treatment blocks electrical signals from targeted areas in the brain. Thus, if newer, more promising treatments develop in the future, the DBS procedure can be reversed. The stimulation may be programmed and adjusted non-invasively by the clinician—without further surgery—to continually maximize symptom control and minimize side effects over time.
The Food and Drug Administration (FDA) has approved DBS for the treatment of Parkinson’s disease, Essential Tremor, Dystonia, and Obsessive-Compulsive Disorder. DBS also has the potential to treat other diseases such as depression and epilepsy. With the expanding capabilities of DBS, it is important for physicians and patients to become educated and aware of these treatment options.