Deep Brain Stimulation (DBS): Advantages and Risks

DBS involves the placement of electrodes into deep brain structures. Current is administered through these electrodes by an implanted power pack, which can be remotely controlled by the subject and adjusted by physicians. In essence, DBS is like a pacemaker for the brain.

Deep brain stimulation (DBS) is used in a variety of clinical settings, predominantly in patients with poorly controlled movement disorders. Although effective, its exact mode of function continues to be poorly understood.

Deep Brain Stimulation (DBS)

DBS is designed to alter the function of circuits in the brain. It has been used with varying degrees of success in the treatment of Parkinson’s disease, dystonia, epilepsy, obsessive-compulsive disorder and even depression.

Careful patient selection and target selection are essential if the procedure is to have good efficacy.

Deep brain stimulation (DBS) is an elective surgical procedure in which electrodes are implanted into certain brain areas. These electrodes, or leads, generate electrical impulses that control abnormal brain activity.

The electrical impulses can also adjust for the chemical imbalances within the brain that cause various conditions. Stimulation of brain areas is controlled by a programmable generator that is placed under the skin in the upper chest.

The DBS system involves three distinct components:

• The electrode, or lead, is a thin, insulated wire inserted through a small opening in the skull and implanted into a specific brain area.
• The extension wire is also insulated and passed under the skin of the head, neck and shoulder, connecting the electrode to the internal pulse generator (IPG).
• The IPG is the third piece of the system and is usually implanted under the skin in the upper chest.

Deep Brain Stimulation (DBS)

Conditions that are treated using DBS are:

• Dystonia
• Epilepsy
• Essential tremor
• Obsessive-compulsive disorder
• Parkinson's disease

Causes

DBS is a surgical intervention used to treat patients with movement disorders such as essential tremor, Parkinson’s disease and dystonia. It can also be used to control symptoms of obsessive-compulsive disorder and epilepsy. This procedure is utilized when medications are no longer effective for patients maintaining good quality of life.

These diseases affect hundreds of thousands of people worldwide. DBS has been used to treat over 160,000 people for various neurological conditions.

Deep Brain Stimulation (DBS)

Symptoms

Each disease type has a variety of symptoms that patients may experience. Common ones are:

Dystonia

• Involuntary muscle contractions occurring during specific actions (e.g. writing)
• Muscle contractions worsen with stress, fatigue or anxiety

Epilepsy

• Temporary confusion
• A staring spell
• Loss of consciousness
• Uncontrollable jerking movements of arms or legs
• Emotional responses such as fear, anxiety or déjà vu

Essential Tremor

Tremor occurring during daily activities like writing or drinking

Obsessive-compulsive Disorder

• Fear of germs or contamination
• Aggressive thoughts towards others or one’s self
• Having things in symmetrical or in perfect order
• Excessive cleaning or handwashing
• Compulsive counting
• Checking things repeatedly (e.g. oven is off, door is locked, etc.)

Parkinson’s Disease

• Tremor
• Bradykinesia – slowing down of movement
• Stiffness
• Abnormal walking

When & How to Seek Medical Care

DBS is used when medications are no longer effective for patients maintaining good quality of life. See your doctor if any of the above symptoms are persistent for an extended period to discuss if DBS is the right treatment.

Testing & Diagnosis

There is a multidisciplinary team of professionals including a neurologist, neurosurgeon, neuropsychologist and psychiatrist that may care for patients. Often patients with Parkinson’s disease or tremor may undergo testing of motor symptoms on and off medications to assess the severity of the disease. Epilepsy testing may include electroencephalography, including more advanced testing. Certain patients may undergo neuro-psychological evaluation during evaluation. Obsessive-compulsive disorder patients must complete Yale-Brown Obsessive Compulsive scale (YBOCs) testing.

Prior to surgery, patients undergo:

• Blood and urine tests
• This helps identify toxins and abnormalities
• MRI and/or CT scans
• Imaging can help doctors target the right area of the brain for symptom relief.
• Medical Clearance

Candidates for DBS meet these criteria:

• Symptoms are substantially reducing quality of life.
• Symptoms are uncontrolled despite receiving the suitable dose of medications.
• Side effects stemming from current medications cannot be tolerated

Deep Brain Stimulation (DBS)

Treatment

Non-Surgical Treatments

Before being considered for surgical interventions such as DBS, doctors may consider any of the following treatments.

• Medications
• Physical Therapy

Surgery

Advantages

• Can be performed on one or both sides of the brain, depending on symptoms.
• The effects are reversible and can be customized individually for each patient’s clinical status.
• Stimulation settings can be modified to diminish potential side effects and improve effectiveness over time.
• The device can provide continuous symptom control 24 hours a day.
• Patients who have undergone DBS can participate in other treatments, such as stem cell or gene therapy, when they become available.

Risks may include:

• 1% risk of brain hemorrhage, including stroke
• Infection
• Device malfunction
• Lack of benefit for certain symptoms
• Headache
• Worsening mental or emotional status

During stimulation, side effects may include:

• Temporary tingling in the face or limbs
• A feeling of pulling in muscles
• Speech or vision problems
• Loss of balance