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Deep brain stimulation (DBS) is a neurosurgical procedure in which electrodes are implanted in certain areas of the brain. These electrodes send electrical impulses to the areas of the brain responsible for body movement and regulate abnormal impulses. Electrical stimulation can affect other cells and chemicals within the brain.
DBS is often described as being similar to a heart pacemaker. It works much the same, sending electrical signals to the brain instead of the heart.
Deep brain stimulation surgery is typically used to treat various disorders and diseases, such as Parkinson's disease, essential tremor, dystonia, epilepsy, and obsessive-compulsive disorder.
In addition, deep brain stimulation is being studied as a possible treatment for the following conditions: Tourette's syndrome, Huntington's disease and chorea, chronic pain, and cluster headaches.
It is important to understand that DBS surgery does not offer a cure for the disease, but it does offer a way to control it more effectively. It can offer patients many advantages, such as being able to take less medication and therefore suffer fewer side effects.
The implantation process for deep brain stimulation consists of a single surgery to insert the components of the electrodes and battery. The patient is given approximately 3 to 6 weeks to allow for sufficient recovery.
At Instituto Clavel, we perform the stage 1 procedure with the patient under general anesthesia, unlike some other centers where this procedure is performed with the patient awake. We are able to complete this procedure in 3 hours. Due to the advance planning of high-resolution images and neuronavigation, intracerebral monitoring is not needed during this surgery, allowing us to shorten the surgical time, and it is as safe, or safer, than performing the same surgery using intraoperative neurophysiological monitoring. Working this way, we achieve more effective results and there are fewer complications.
In this first stage, electrodes are implanted in specific areas of the brain. The patient's head is placed in a special frame with small screws to immobilize it for the duration of the procedure. Sometimes the procedure is done with an MRI and a frame is used above the head instead of around it.
The surgeon will drill a small opening in the skull and place the lead in a specific area of the brain. (If both sides of the brain must be treated, the surgeon will make an opening on both sides of the skull and insert two leads.)
Small electrical impulses will be sent through the lead during the procedure so that the surgeon can check that the electrodes are properly connected to the area of the brain responsible for the patient's symptoms.
In Stage 2, the patient is also under general anesthesia. It is in this phase that the pulse generator, or "brain pacemaker", will be implanted.
The surgeon makes a small incision, in most cases just below the collarbone, and implants the neurostimulator. It is placed under the skin of the thoracic area, near the collarbone, and will be connected with wires to the electrodes that were implanted in Stage 1.
Once connected, the surgeon closes the incision. As the neurostimulator and wires are inserted just beneath the skin, there may be a small, visible bump. Once the wires have been connected, they transmit electrical impulses from the neurostimulator directly to the brain. These impulses interfere with and override the electrical signals that cause the symptoms of some diseases.
The patient’s recovery time depends on various factors, such as the patient's overall health, or other conditions they have. The first 24 hours following the surgery the patient is kept under observation in the ICU, and the normal overall hospital stay is from 4 to 5 days. For home care, it is important to keep the incisions clean and dry.
A few weeks after the surgery, the patient comes for an appointment in which the doctor will activate the pulse generator in the patient's chest. This activation is done externally, with a special remote control. The level of stimulation is personalized, depending on the disease, and the case of the individual patient, and several appointments may be needed to adjust the schedule of pulses to the right level. The stimulation may be constant, or the doctor may recommend turning off the pulse generator at night and turning it back on in the morning. For this reason. the patient will take the remote control home to use according to the doctor’s orders.
The life of the battery in the pulse generator will last longer or shorter depending on the usage level and configuration of the generator. When the battery needs to be replaced, the surgeon will replace the generator during an outpatient procedure.
Deep brain stimulation involves making small holes in the skull to implant electrodes in brain tissue, in addition to the surgery to place the device containing the batteries in the chest.
General complications of any surgery are bleeding, infections, blood clots, respiratory or cardiac complications, and reactions to anesthesia such as nausea or seizures. In the case of deep brain stimulation, complications related to it could be incorrect placement of the extension wires, bleeding in the brain, or stroke.
If you develop any side effects as a result of the stimulations, you should see the doctor again.
Contact us so that we can give you a personalized assessment.