Deep brain stimulation treatment is used to relieve a number of damaging symptoms associated neurological conditions such as Parkinson’s disease and essential tremor. It is a surgical procedure used for treatment of neurological patients when the symptoms cannot be treated with the help of medicines.

Deep brain stimulation treatment involves the use of a pacemaker-like device to send electrical impulses to the parts of the brain that are required to be deactivated. Although researchers around the world are not sure how this treatment actually works, deep brain stimulation helps relieve the symptoms by blocking specific signals that lead to discomfort associated with the condition.

Deep brain stimulation treatment is most commonly used in the case of Parkinson’s disease. However, its use has also been studied for Alzheimer’s disease. According to a Canadian team of researchers, the use of deep brain stimulation treatment is completely safe for early Alzheimer’s patients as it helps lower the pace of memory loss and mental decline.

During a clinical trial conducted on 42 patients with moderate Alzheimer’s symptoms, the researchers noted that deep brain stimulation treatment does help slow down memory loss in patients above 60, without producing any unusual side effects. In addition, sugar metabolism increased in the patients who received treatment. However, the treatment did not seem to help patients aged less than 65.

This article examines the answers to some of the common questions about deep brain stimulation treatment that patients and their families have in their mind.

What is deep brain stimulation actually?

Deep brain stimulation is a surgical technique used to inactivate the areas of the brain that produce symptoms related to different neurological conditions. While deactivating the brain, the damage to the nearby healthy areas of the brain is completely prevented.

Deep brain stimulation helps produce the same impact as that of surgical procedures such as pallidotomy and thalamotomy.

How does it work and what happens during the treatment?

How deep brain stimulation actually works continues to remain a mystery. However, it is widely believed that it helps block the impulses that result in discomforting symptoms in case of neurological conditions. It does not damage the nerve cells, but just prevents the specifically identified areas of the brain from sending electrical signals.

During deep brain stimulation treatment, the doctors first identify the targeted area of the brain by performing a CT scan, MRI scan or using the electrode recording technique. The patient remains awake during this procedure so that the doctors are able to figure out the exact locations with the help of patient response. Next, permanent electrodes are implanted near the identified areas.

These electrodes are connected to a small device called a pulse generator that resembles a pacemaker. This device is placed underneath the chest skin of the patient. Once the pulse generator is activated, it send regular electrical impulses to the brain.

The impulses are transmitted to the targeted areas of the brain with the help of electrodes, which further prevents the brain from sending signals that cause symptoms associated with the neurological condition in question.

The patient is provided with a remote control, thus enabling them to switch signals on or off at their own will.

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What types of symptoms can deep brain stimulation treat?

Deep brain stimulation treatment helps treat movement-relates symptoms and improve tremors in patients who suffer from different neurological conditions. These symptoms are typical of Alzheimer’s diseases, Parkinson’s disease, Tourette’s syndrome and obsessive compulsive disorder.

In some cases, deep brain stimulation has also been used for the treatment of chronic pain and mood-related problems observed in case of depression. Out of all the aforementioned conditions, it is most commonly used in the case of Parkinson’s.

Deep brain stimulation may help stimulate three parts of the brain – subthalamic nucleus, globus pallidus and thalamus. Depending on the type of stimulation, the treatment may help relieve problems with walking and balance, rigidity, tremor and slow movement.

What are the advantages of using deep brain stimulation as compared to other options?

Deep brain stimulation treatment has several advantages over other surgical options available – pallidotomy and thalatomy. Some of these advantages are listed below.

• It is a simple procedure that can help alleviate a majority of the symptoms
• It helps improve quality of life drastically
• Some of the advantages of deep brain stimulation over other options include:
• No area of the brain is purposefully destructed
• Less side effects or complications after the procedure
• Electrical stimulation is not permanent as its intensity is in the control of the patients
• The course of treatment can be adjusted according to the recovery of the patient
• Brain cell transplantation can be conducted in patients treated with deep brain stimulation
• Stimulator can be turned off in case of side effects

What is the efficacy of this treatment option?

It is estimated that 70 percent of the people who receive deep brain stimulation treatment experience improvement in terms of symptoms and are more capable of performing daily tasks. In addition to improving quality of life, this treatment helps reduce medications over a period of time.

Who all are eligible for deep brain stimulation treatment?

Patients or their family members should have a thorough discussion with a movement disorder expert before deciding whether deep brain stimulation treatment is actually required. In some cases, a surgery is recommended. Age, overall health of the individual and their stamina must be considered before making the final decision.

Typically, for the treatment of Parkinson’s disease, an eligible candidate is the one who has:

• Experienced symptoms for at least five years
• Not received any benefit from medications such as selegine, amantadine or entacapone
• Experienced symptoms that interfere with daily life
• Received response from medications, but only for a short duration
• Tried medications for movement disorders

What are the after effects of the treatment?

Since you are required to remain awake during the deep brain stimulation treatment, you may expect to feel a little sore or tired after it. However, the doctors will give you medications to make you feel comfortable and relax.

You may also feel a little irritation or soreness around the stitched site of the skin on your chest. Talk to your doctor in advance about the surgery to relieve the anxiety that you may have from certain concerns.

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How long does it take to recover?

Recovery after deep brain stimulation treatment mostly involves taking care of the stitches, incision wounds and the pain that may result after the surgery. As compared to other procedures, the recovery is simple and quick in case of deep brain stimulation.

The doctors may turn on the pulse generator only after the patient has fully recovered. It may also be customized according to the need of the patients and their rate of recovery.

Medication may also be given to support the treatment. However, in some cases, the use of medicine is completely avoided.


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What can I expect before the procedure?

Before the procedure, you may expect the doctor to discuss about the risks associated with the deep brain stimulation procedure and if there are any alternatives available for the surgery. If deep brain stimulation is decided as a treatment option, the doctor will discuss the complete treatment plan with you. In addition, a series or scans including CT scan and MRI may be conducted to identify the target areas for electrode implantation.

What can I expect after the procedure?

You can experience tiredness and soreness after the procedure, however, it will be taken care of with the help of medications. You may be required to stay in the hospital for 24 to 48 hours after the surgery. Several follow up sessions will be conducted after the surgery so that the doctors can assess the effectiveness of the treatment and the overall improvement. The intensity of the electrical impulses produced by the pulse generator can be adjusted accordingly.

You may expect the stitches to be removed 7 to 10 days after the surgery. However, care must be taken to keep your head and the stitch area dry. Scratching around the wounds area should be completely avoided.

What precautions should I take after the surgery?

After the surgery, you should:

• Not engage in heavy exercises or strenuous exercises.
• Not lift heavy weights
• Keep the magnet used to activate or deactivate the pulse generator away from credit card, mobile and other electrical items
• Avoid screening devices and detectors, such as theft detectors and those places in malls and airport. These may switch off the pulse generator.

What are the risks associated with deep brain stimulation treatment?

Deep brain stimulation treatment does not cause side effects in all cases. However, in some cases, it may result in side effects typical of an invasive surgery, such as:

• Infection
• Irritation
• Inflammation
• Bleeding

When the pulse generator is turned on, the patient may experience nausea, vomiting, balance issues, confusion, mood swings, seizures, change in vision, fever or chills, headache or light-headedness. You must consult a doctor in case any of these symptoms persists after the surgery. These may be corrected during the follow-up period with the help of medications.

References:

http://www.webmd.com/parkinsons-disease/guide/dbs-parkinsons