Deep Brain Stimulation (DBS) surgery
- What is Deep Brain Stimulation?
- Indications and contraindications for DBS surgery
- Preparation for DBS surgery
- Process of Deep Brain Stimulation procedure
- What happens after the surgery?
- Deep Brain Stimulation - FAQ
What is Deep Brain Stimulation?
Deep Brain Stimulation (DBS) is neurosurgical procedure aimed at fast and effective treatment of neurological disorders as:
- Parkinson’s disease;
- essential tremor;
- multiple sclerosis;
- obsessive-compulsive disorder;
- Tourette syndrome.
Nowadays the DBS procedure is the most efficient treatment method for Parkinson’s disease. Moreover, in 2016, DBS surgery was approved for its earlier stages.
Thin electrodes are inserted into the brain through small orifice with following deep structures stimulation by means of brain stimulator. The device is fixed under the skin in the chest area. The electrodes are connected to the stimulator by extension cord, which is held under the skin.
Electrodes and brain pacemaker connection scheme
Clinics specialized in neurosurgery and Deep Brain Stimulation provide the operation with 100% accuracy and effectiveness.
Indications and contraindications for DBS surgery
- Medications are non-effective;
- Severe tremor and motor disturbance;
- Painful dystonia;
- Allergy or strong side effects after administration of medications.
There are no severe contraindications for DBS providing, however some relative ones could make the surgery or preparation for surgery more difficult, including:
- patient is older than 75;
- simultaneous thermoradiotherapy;
- immunological suppression;
- brain atrophy;
- some psychological disorders, mental disability.
Preparation for DBS surgery
Before Deep Brain Stimulation providing, a patient should undergo the following diagnostics:
During the examination, the doctor clarifies whether patient has any allergic reaction on medications and anesthesia.
- In the week leading up to the surgery, a patient is forbidden to take any anti-inflammatory agents.
- Moreover, a patient is forbidden to smoke and take alcohol 1 week to and 2 weeks after the surgery, as this could cause bleeding. It’s also prohibited to eat and take any medications right before the surgery.
- Patients should come to the hospital 2 hours before the surgery to finish with all written arrangements and be briefed on anesthesia effect and possible risks.
Process of the Deep Brain Stimulation surgery
Deep Brain Stimulation for Parkinson’s takes from 5 to 7 hours.
The operation is carried out by the team of at least 5 specialists: neurosurgeon, anesthesiologist, radiation therapist, neurologist, psychiatrist, who control functional abilities of the brain for maximum accurate impact on the zone of stimulation.
- Stage 1. At the time of the operation patient is under local anaesthesia, but remains awake. This is a mandatory requirement, as far as he/she is asked to move the extremities, fingers, eyes, or to say anything - to check and make sure electrodes do not stimulate off-target brain areas. All the impulses - firstly from the brain into the recorded device, and then vice versa - are transferred as structural information into the monitor. Data are processed in real time, which helps to adjust the device simultaneously. The orifice is closed with lead, surgery area is stitched.
- Stage 2. After the electrodes adjustment, the temporary device is changed into constant brain stimulator, which is placed into the chest or the abdomen. Its size is not bigger than heart pacemaker.
What happens after the surgery?
Patient feels the improvement in first hours after the surgery performing. The trembling in extremities disappears, movement coordination and speech articulation are renewed. Few days after the surgery sleeping and general health condition become better, pain is gone.
After the DBS surgery a patient with Parkinson’s disease is easily repeating the moves of the neurologist.
Every 3 weeks after the procedure a patient is recommended to appoint neurologist to check the settings of the brain stimulator. 3-4 visits are required in general.
After the final neurostimulator programming, patient can control the parameters by him/herself, choosing the pre-installed regimes. As a rule, brain stimulator works 24h. There are different types of the neurostimulator devices: with battery and accumulator. Accumulator charge is 12-14 days, the total charge cycle is 1-2h.
Cell phones, beepers, microwave ovens, electromagnetic sensors do not affect brain stimulator.
Deep Brain Stimulation - FAQ
- Does DBS mean craniotomy?
No, all the manipulations are made through small orifices (the size of the orifice depends on the neurostimulator device, qualification and experience of neurosurgeon).
- Is the surgery provided under local or general anesthesia?
The first stage - electrodes insertion - of the surgery is provided under local anesthesia. The second - constant stimulator putting is performed under general anesthesia.
- What complications could appear during and after the surgery?
There are some possible complication that could arise during and after the Deep Brain Stimulation procedure: brain hemorrhage, infection, reaction to anesthesia. However, these conditions are rare and make out less than 1%.
- What are the Deep Brain Stimulation side effects?
Deep Brain Stimulation have very few side effects (headache, disorientation, problems with hardware, unwanted mood depression).
- What is the prognosis after DBS?
Most of the patients still need to take medications after DBS procedure, however in much smaller quantity which significantly lowers the medication side effects (incl. dyskinesis - notwilled movement, caused by longstanding levadopa taking). More than 70% of people feel a compelling improvement of tremor, movement slowness, rigidity, walking and balance problems as well.
- Is MRI necessary before the procedure? If I have heart pacemaker and can’t make MRI?
MRI is the most informative diagnostics method prior to DBS. If it is impossible to provide it, a patient makes computer tomography or DaTscan.