Wednesday, May 4, 2022

How Does Deep Brain Stimulation Work

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What Kind Of Results Can You Expect After Having Dbs

Deep Brain Stimulation …. How does DBS work

A few weeks after the surgery, a specialist will program the DBS settings to your symptoms.

DBS wont eliminate symptoms, but more than 70 percent of people with Parkinsons experience a significant improvement.

Youll likely be able to cut back on medication. DBS settings can be adjusted without surgery. It may take a few months to find the best combination of medications and DBS settings.

Deep Brain Stimulation Surgery: What To Expect

DBS surgery is almost always done in two stages that are usually separated by one to two weeks. In certain circumstances, both surgeries can be performed on the same day.

Stage One: Lead Placement SurgeryIn this first stage, DBS electrodes are implanted into the brain. This surgery usually takes about four hours in the operating room. At least part of your head will be shaved at the beginning of the procedure.

  • If you are undergoing asleep surgery, youll remain asleep and unconscious throughout the procedure.
  • People undergoing awake surgery will be awake for parts of the procedure. This allows you to answer questions and respond to commands, which helps ensure the leads are in the right place and avoid unwanted side effects. Your neurologists and neurosurgeons will work with you to select the procedure type based on your preference and condition.
  • After you have received anesthesia and are unable to feel pain, your neurosurgeon will make one or two incisions on the top of your head behind your hairline. Using a sophisticated targeting system as a guide, the surgeon will then implant the electrodes in the brain through nickel-sized holes that have been drilled in the skull. During awake surgeries, a brief 30-45 minute period of testing will be performed. Then the ends of the wires are tucked under the scalp so they can be later accessed during the second stage of surgery.
  • After the procedure, youll need to stay in the hospital for one or two nights to recover.

Surgical Relief For Neurological Disorders

When medication isnt enough to control symptoms of certain neurological disorders, deep brain stimulation can be a viable option for symptom relief. For those who experience tremors, stiffness, slowness and involuntary movements, performance of daily tasks can be difficult or frustrating.

While DBS doesnt provide a cure, it can be used to significantly control symptoms for a number of conditions for many years. For example, DBS is the most commonly performed surgical treatment for Parkinsons disease and can help reduce symptoms such as tremor, stiffness and slowed movement while allowing a reduction in medication. Often, the reduction in medication improves many side effects.

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About The Dbs Procedure

Deep brain stimulation therapy uses a small, pacemaker-like device to send electrical signals to an area in the brain that helps fine-tune and control movement. The electrical brain stimulation may, in some cases, block some of the brain messages that cause involuntary and disabling motor symptoms. The device is implanted under the skin in the chest. Small, thin wires connect the device to electrodes placed in your skull, allowing the signals to reach the areas of your brain that are causing your symptoms.

After the DBS system is implanted, your expert DBS programmer adjusts the settings to personalize your DBS therapy. You may need several programming sessions to find your optimal settings. The settings can be adjusted in the future if your symptoms change. Most people do not feel the stimulation, though some may sense a brief tingling when the stimulation is first activated.

A few weeks after the procedure, most patients can resume normal daily activities. Your DBS clinician will let you know when you can try activities that had been difficult for you prior to deep brain stimulation surgery.

DBS surgery recovery and healing

Patients are usually able to return home the day after DBS surgery. Healing can take several weeks, and we will give you medication to manage any pain. Typically, we will not activate your device until your first programming session.

DBS programming sessions

Risks of DBS surgery

What Are The Pros And Cons Of Deep Brain Stimulation

How does a deep brain stimulation device work?

Advantages of deep brain stimulation include:

  • It doesn’t destroy brain tissue and won’t limit future treatment.
  • The device can be removed at any time.
  • It is adjustable.
  • It may be more effective in controlling tremors than thalamotomy, or destruction of the thalamus.

Disadvantages of deep brain stimulation include:

  • Increased risk of infection from the presence of a foreign object in the body
  • Repeat surgery every three to five years in order to replace the battery in the device
  • Uncomfortable sensations that may occur during stimulation

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Deep Brain Stimulation Expertise At Wake Forest Baptist

The Movement Disorders Center at Wake Forest Baptist has one of the most experienced deep brain stimulation teams in the country. We were among the first centers in the nation to use DBS in patients with Parkinsons disease and we continue to innovate in the use of this treatment in other FDA-approved movement disorders, including essential tremor, dystonia and obsessive-compulsive disorder.

Our specialists work closely with a multidisciplinary team to develop an extensive, individualized plan for each patient. The MDC coordinator helps referring providers and patients navigate our system and provides you with the best possible medical experience.

How Long Does The Battery In The Impulse Generator Device Last

Batteries can last 3 to 5 years in non-rechargeable devices and up to 9 years in rechargeable battery devices. However, these times may vary significantly. A simple outpatient procedure is needed to replace the battery. Rechargeable battery devices can be charged daily or every 10 to 14 days . Your doctor will discuss how often you should recharge your battery based on your therapy settings.

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Deep Brain Stimulation Results

DBS is perhaps most famously used in the treatment of Parkinson’s disease. Prominent actor Michael J. Fox helped to bring Parkinson’s to the eyes of the public when he revealed his diagnosis with the disease. Essential tremor and dystonia are two other movement disorders that are also commonly treated with DBS. Essential tremor is characterized by tremors during muscle movements and is actually the most common movement disorder in the United States. Usually medication alone is sufficient to treat essential tremor, but sometimes severe cases require treatment with DBS.

Dystonia is a disorder resulting in unwanted muscle contractions. Notably, the DBS implantation surgery is performed differently in the case of dystonia. Because dystonia patients are unable to suppress the head and neck movements that are part of their symptoms, the patients must be placed under general anesthesia during the electrode implantation surgery. As we’ll later learn, this situation can make proper electrode implantation more challenging for the doctor.

Parkinson’s disease, essential tremor and dystonia are all movement disorders that share symptoms treatable by DBS stimulation to the basal ganglia. DBS can also be used on brain regions outside the basal ganglia to treat other conditions caused by abnormal brain function. The most common use of DBS is actually for the treatment of chronic pain.

What Are The Risks Of The Dbs Therapy Implant Procedure

Deep Brain Stimulation How does DBS work

DBS Therapy requires brain surgery. Risks of brain surgery may include serious complications such as coma, bleeding inside the brain, seizures and infection. Some of these may be fatal. Once implanted, the system may become infected, parts may wear through your skin, and the lead or lead/extension connector may move. Medtronic DBS Therapy could stop suddenly because of mechanical or electrical problems. Any of these situations may require additional surgery or cause your symptoms to return. Talk to your doctor about the risks that may be applicable to your specific situation.

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Living With A Stimulator

Once the DBS has been programmed, you are sent home with instructions for adjusting your own stimulation. The handheld controller allows you turn the stimulator on and off, select programs, and adjust the strength of the stimulation. Most patients keep their DBS system turned on 24 hours day and night. Some patients with essential tremor can use it during the day and turn off the system before bedtime. Your doctor may alter the settings on follow-up visits if necessary.

If your DBS has a rechargeable battery, you will need to use a charging unit. On average charging time is 1 to 2 hours per week. You will have a choice of either a primary cell battery or a rechargeable unit and you should discuss this with you surgeon prior to surgery.

Just like a cardiac pacemaker, other devices such as cellular phones, pagers, microwaves, security doors, and anti theft sensors will not affect your stimulator. Be sure to carry your Implanted Device Identification card when flying, since the device is detected at airport security gates.

Deep Brain Stimulation And Depression: How Does It Work

In the previous blog posts, Deep Brain Stimulation was introduced, then the history of psychosurgery leading up to the treatment of depression was traced. In this post, we will cover some of the neurological theories as to why it is an effective treatment. We will begin with the prevailing theories behind the treatment of depression with DBS, then move on to explore some more novel ideas.

This images shows changes in oxygen and other metabolic usage in different areas of the brain following chronic DBS treatment

The most commonly targeted area of the brain in DBS for depression is the Subcallosal Cingulate Gyrus , which has been known to be heavily involved in mood regulation. Early studies showed that both successful pharmacotherapy and psychotherapy lead to reductions of activity in this area. Lozano et al furthered these studies by showing decreases in activity in the orbital and medial prefrontal cortices and insula, as well as increases in the parietal lobe, mid and posterior cingulate gyri. Most importantly, their study showed increases of activity in white matter immediately next to the electrodes. The discovery of a wide range of affected locations, as well as the activity in connective tracts, became a key step in establishing the treatment of depression as the treatment of a network.

This image shows the dual-loop system. Regions in brown are the fast inner loop, and blue regions are part of the slower outer loop.

Works Cited:

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What Should I Expect After Deep Brain Stimulation Surgery

After deep brain stimulation surgery, you may feel tired and sore but will be given medication to keep you comfortable. Also, you may have irritation or soreness around the stitches and pin sites.

As with any surgery, there are some guidelines and limitations that you should follow after DBS. Be sure to discuss these with your doctor and ask questions before surgery. Understanding what you will be experiencing and knowing what to expect afterward can help ease some of the natural anxiety that comes with any medical procedure.

Placement Of The Neurostimulator

How Does Deep Brain Stimulation Work?

This procedure takes place under general anesthesia so that the person is asleep. The surgical team inserts the neurostimulator under the outer layers of skin, usually just under the collarbone, but sometimes in the chest or abdomen. The extension wire from the lead is attached to the neurostimulator.

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Living With A Dbs Device

Batteries most often last three to five years, but this can vary. Rechargeable batteries may last up to 15 years.

There are several precautions related to electrical/magnetic devices that are important, but usually easy to accommodate. Items such as cell phones, computers, and home appliances do not generally interfere with the stimulator. Keep your stimulator identification card handy when you are out and about, in your wallet or purse.

Theft Detectors

Be aware that some devices may cause your transmitter to turn on or off. This includes security monitors that might be found at the library and retail shops.

If this occurs accidentally, it is not usually serious, but may be uncomfortable or result in your symptoms worsening if the stimulator is turned off. When you visit stores with these devices, you can ask to bypass the device by presenting your stimulator identification card.

Home Electronics

Keep the magnet used to activate and deactivate the stimulator at least 12 inches away from televisions, computer disks, and credit cards, as the magnet could potentially damage these items.

Air Travel/Metal Detectors

Talk to TSA personnel when traveling by plane, as the metal in the stimulator may set off the detector. If you are asked to go through additional screening with a detector wand, its important to talk to the person screening you about your stimulator.

Medical Diagnosis and Treatment

Occupational Electromagnetic Concerns

How Is The Surgery Performed

UPMC was one of the first centers to use ROSA robotic assistance for the placement of DBS electrodes. ROSA is similar to a GPS device for the brain. It provides the surgeon with a roadmap to reach the intended brain targets. The patient is sedated for the beginning of the surgery while we make a small opening in the skin and bone at the surgical site. The patient will not feel or remember this part of the surgery, but once these steps are complete, he is awoken for the remainder of the surgery.

Brain MappingWe use neurophysiology recordings from very thin electrodes inserted into the brain to map activity in the intended target and confirm the best spot for the DBS electrode. It is important for the patient to be awake during this part of the surgery so we can obtain the best recordings possible, which will aid in the most accurate placement of the DBS electrode. The brain mapping is not painful and the surgical team will be available to provide reassurance and feedback the entire time.

Intra-Operative Stimulation TestingWhen the best site is identified from the brain mapping, the DBS electrode is inserted and tested. We monitor the patient for improvement in his symptoms, for example tremor, and also ask him to report any new sensations he experiences. Again, this part of the procedure is not painful, but provides valuable feedback to the surgical team.

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Best Destination Or Hospital For Dbs Surgery:

Indian healthcare personnel has experience working worldwide and possess the essential abilities to perform successful deep brain stimulation surgery. The doctors degree of expertise is exceptional and deserves praise. The post-operative care and therapy that the patients receive are simply exceptional.

This is why only a highly skilled and experienced surgeon should do this procedure. India is known for producing a big number of highly proficient brain surgeons who have studied at some of the worlds top medical schools. When compared to other western countries, deep brain stimulation treatment in India is more reasonable.

If we talk about the cost, deep brain stimulation surgery costtotally depends upon the medical or the condition of the patient, tools, number of days stay in the hospital, medication, and the device used during the surgery.

Deep Brain Stimulation Evaluation

How does Deep Brain Stimulation (DBS) surgery work?

If you have been referred to the Movement Disorders Center, you will undergo a comprehensive evaluation for level of qualification and DBS risk.

Your DBS-trained movement disorders neurologist will confirm your diagnosis, grade its severity, ensure your medications are optimized, and determine and explain which symptoms can be expected to respond to surgery.

You will undergo a thorough evaluation by a team of neurosurgeons, neurologists, psychiatrics, neuropsychologists and therapists. This evaluation includes a detailed health history, neuropsychological evaluation, psychiatric evaluation, physical exam and, potentially, a videotaped evaluation both on and off your medicine.

Not all patients need DBS we often advise patients whose conditions are well managed with current medication to defer surgery to a later time.

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What You Need To Know

  • Surgeons implant one or more small wires in the brain during a surgical procedure.
  • The leads receive mild electrical stimulation from a small pulse generator implanted in the chest.
  • Proper patient selection, precise placement of the electrodes and adjustment of the pulse generator are essential for successful DBS surgery.
  • DBS does not fully resolve the symptoms of PD or other conditions, but it can decrease a patients need for medications and improve quality of life.

What Parts Of The Brain Does Dbs Target

Deep brain stimulation targets three areas in the brain. Each patient who has DBS has only one of these targets stimulated, as they do different things. A patients disease, disability and safety determines which target to stimulate.

  • Ventralis intermedius nucleus of the thalamus This powerful anti-tremor target is primarily used for essential tremor, sometimes PD
  • Subthalamic nucleus This target helps to suppress tremor as well as reduce slowness and stiffness a primary target for PD, sometimes dystonia
  • Globus pallidus interna This target helps reduce slowness and stiffness as well as tremor, suppresses excessive movements and is a primary target for PD and dystonia
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    How Does Dbs Treat Parkinsons

    Parkinsons disease causes irregular electrical signals in parts of the brain that control movement. DBS uses electrical stimulation to modulate these control centers deep to the surface of the brain, improving communication between brain cells.

    This helps to reduce symptoms such as tremor, slowness, and stiffness. It doesnt have much of an effect on non-motor symptoms or balance issues. Here are some additional tips for improving motor skills with Parkinsons.

    DBS is the most commonly performed surgical procedure for symptoms of Parkinsons disease.

    DBS isnt a first-line therapy. Its intended for people whose symptoms are still unmanageable even with medication. Learn about other advanced and future treatments for Parkinsons.

    You might be a good candidate for DBS if:

    • youve had symptoms for at least five years
    • your symptoms respond to medication, but the effect doesnt last as long as it used to
    • youve tried various doses and combinations of medications
    • your symptoms interfere with everyday life

    Your doctor is unlikely to recommend DBS if:

    • Parkinsons medications havent helped much
    • you have memory and thinking problems
    • you have anxiety or depression that hasnt stabilized with treatment
    • you have dementia

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