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Deep Brain Stimulation

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What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is one of the surgical treatment options involving implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. This surgical procedure is used to treat severe tremor, Parkinson's disease, as well as primary dystonia. Brain pacemakers were approved by the Food and Drug Administration (FDA) in 1997 as a treatment for Parkinson's disease as well as essential tremor, and in April 2003 as a treatment for primary dystonia. In March 2005, the results of a Canadian study performed by doctors from the University of Toronto were published indicating that DBS may also alleviate symptoms in patients suffering from treatment-resistant clinical depression.

How is it done?

The system is implanted by a functional stereotactic neurosurgeon, that is, a neurosurgeon who is specialized in treating neurological disorders using stereotactic techniques. This means that a stereotactic head frame is used to keep the patient’s head still during surgery and the neurosurgeon uses special imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) to map the brain and locate the position of the site to be stimulated.

There are two parts to the surgery; the procedure to implant the leads, and the surgery to implant the neurostimulator(s) and extensions.

For the first part the patient is usually awake during the placement of the leads so that dialogue with the surgeon can establish precisely which part of the brain is being passed. For the second part, when the surgeon runs the extensions and positions the neurostimulator (generally in the chest wall) during which the patient is fully anesthesized.

The surgery time will depend upon whether one or two leads are to be placed in the brain. Some surgeries last up to five hours or more.

Why is it done?

Deep brain stimulation can provide continuous brain stimulation. Therefore, the abnormal movements (shaking, twisting, stiffness and slowness) will be controlled more smoothly than treatments with medication. Moreover, the doses of the medicines could be reduced or even stopped after deep brain stimulation therapy.

Risks & complications

Potential side effects of Deep brain stimulation:

Tingling sensation
Abnormal, involuntary muscle contractions (dystonia, dyskinesia)
Movement problems or reduced coordination
Jolting or shocking sensation
Numbness (hypoesthesia)

Potential surgical risk

Paralysis, coma, death
Intracranial hemorrhage
Leakage of cerebral fluid surrounding the brain
Seizure
Infection
Allergic response to implanted materials
Temporary or permanent neurological complications
Confusion or attention problems
Pain at the surgery site
Headaches

Alternatives

Exercise. Although not necessarily an "alternative therapy," exercises like Tai chi and yoga can lower your stress, help you to be more relaxed, and increase your energy, balance, and flexibility. In general, exercise is a safe, effective and easy way to improve your well-being. But, check with your doctor first.
Diet. By following your doctor's and dietitian's daily dietary guidelines, you can look and feel better.
Positive Attitude. Having a positive outlook cannot cure Parkinson's disease, but it can lower your stress and help you feel better.
Treatment with medications.

Candidate eligibility

Deep brain stimulation is used for patients:

Who suffer from advanced Parkinson’s disease. Patient should be carefully screened for other movement disorders, which may not respond to Deep brain stimulation.
Who have Parkinson’s disease and have shown benefit from levodopa therapy. Deep brain stimulation has not been shown to improve symptoms that do not respond to levodopa.
Whose symptoms are not adequately controlled by medications.

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