Deep brain stimulation (DBS) is a surgical procedure used to treat symptoms associated with various neurological conditions. Implanted electrodes deliver electrical impulses through implanted electrodes which send electrical pulses that help correct misfiring nerve signals in specific parts of your brain, helping regulate nerve signals more effectively.
DBS surgery is often employed for those suffering from tremor, dystonia or Parkinson’s disease when medications fail to provide relief or cause side effects. Our multidisciplinary team has extensive experience performing DBS surgery on patients at any stage in the process.
What is DBS?
Deep brain stimulation (DBS), using electrodes placed under the scalp to regulate abnormal signals that cause tremors, seizures and other symptoms to remit in some patients – sometimes completely eliminating symptoms and greatly improving quality of life – Deep Brain Stimulation can greatly reduce or even eradicate such issues for many individuals.
DBS can be used to treat movement disorders like Parkinson’s disease, essential tremor and dystonia as well as mental conditions like obsessive-compulsive disorder, major depressive disorder and neuropathic pain. Sometimes DBS may even be combined with medications in order to decrease dosages and side effects of both.
DBS surgery entails inserting thin wires known as electrodes into specific regions of either side of your brain that control movement, then connecting these electrodes to an implanted pacemaker-style neurostimulator placed just under your collarbone in your chest area. A computer program controls this device which sends low-level electrical current directly to electrodes when needed.
Before your surgery, medical tests and brain-imaging studies (such as an MRI or computed tomography scan ) will be performed to ascertain if deep brain stimulation (DBS) is suitable for you. Additional evaluation may include occupational therapy review or speech, language and swallowing evaluation. A psychiatrist can also perform an exam to ascertain if depression or anxiety needs treating prior to starting DBS therapy.
Surgery usually lasts several hours. Your surgeon will administer numbing medication into your scalp and position a head frame to keep your head in its correct position during surgery. Once that has taken place, they’ll create a pouch-like space under your collarbone in which they’ll place the pulse generator before connecting extension wires from electrodes directly to pulse generator. Finally, they’ll stitch closed any wounds left from surgery.
Once your device is in place, your doctor will activate and begin making adjustments – this may take multiple office visits before finding the optimal balance of increased symptom control with minimal side effects.
DBS surgery requires surgical incision, so it’s important to fully comprehend its risks just like you do before playing online slot games on websites recommended at the moxiecafe.com and benefits before making a decision to undergo this surgical process. You will also need to commit yourself to evaluations, procedures and consultations prior to and post-op as well as locate a medical center with expertise and equipment capable of performing DBS procedures in your locality.
What are the Indications for DBS?
DBS is most frequently prescribed to treat Parkinson disease, which often manifests with tremors and movement issues. DBS may also treat dystonia – a muscle condition which interferes with movement and posture – or other conditions like epilepsy, neuropathic pain and treatment-resistant depression. Furthermore, autism, anorexia nervosa and schizophrenia are being researched using DBS technology as potential treatment methods.
To determine your eligibility for DBS, your doctor will evaluate both your symptoms and abilities. Videotaped performances of various movements (walking, finger tapping and rising from chair) with or without medications prescribed for Parkinson’s will also be examined by neurologists; your thinking and memory abilities will also be tested by neurologists; in addition, you will also meet with a psychiatrist who may identify whether depression or anxiety require prior treatment before proceeding with DBS treatment.
DBS may help when medicines no longer provide relief, or side effects restrict daily activities. By disrupting abnormal brain activity and helping certain parts of your brain control movement, speech, vision or emotions more efficiently. While DBS cannot treat all symptoms or improve quality of life significantly; it can significantly lessen symptoms while increasing quality.
Before surgery begins, we will administer an anesthetic injection into your arm and place an intravenous line so we can administer any needed medication throughout. At the outset of DBS treatment, a robot called ROSA guides electrode placement within your brain; once we find an ideal site we insert and test our DBS lead; during testing we look for improvement in symptoms like tremor while simultaneously tracking any new sensations which arise – this step helps us fine-tune DBS therapy and achieve maximum benefit for you.
Once surgery has taken place, you’ll return to the neurologist’s office for DBS adjustments. They will make changes that minimize symptoms while improving function; you will also visit a cardiologist to make sure your DBS system doesn’t affect their heart.
What are the Procedures for DBS?
DBS works by connecting electrodes to an implanted neurostimulator device – similar to an electrical pacemaker – which then delivers electric current directly into your brain area targeted by it, relieving symptoms. Electrodes are placed via minimally invasive surgery in your skull while an implanted pulse generator remains concealed underneath your skin near your collarbone.
At first, we perform magnetic resonance imaging (MRI) and computed tomography (CT) scans to identify which parts of your brain are contributing to your movement issues, and to locate an ideal position for our electrode placement surgery while you remain conscious. After surgery is performed while awake, tasks will be assigned that help our highly trained neurosurgeon team locate optimal locations for our electrode placement – this process is known as brain mapping.
Our surgeon will create a pocket under your skin near the collarbone to house the device, before inserting extension wires from DBS electrodes into it and connecting these to a neurostimulator device before sewing up any tissues that remain. The procedure typically lasts one day and you should expect to stay in hospital overnight afterwards.
Your doctor will program your device so it delivers an electrical signal which improves symptoms while minimizing side effects. This may require multiple visits over weeks or months and modifications may need to be made in your activities to protect both leads and body parts from being damaged in any way.
However, as with any surgery there can be potential risks and complications with DBS surgery. You and your healthcare provider will discuss any possible complications or risks with regard to your individual health history and personal circumstances.
DBS may offer long-term benefit to carefully chosen people with Parkinson’s disease or essential tremor. DBS has been proven to significantly decrease symptoms related to these conditions, thus improving quality of life while potentially eliminating or greatly decreasing doses of medications required. DBS may be combined with physical therapy sessions as well as therapies which target their underlying causes in order to get optimal results.
What are the Risks for DBS?
DBS can be an empowering solution for certain conditions that cause movement disorders, when medications no longer prove effective or when side effects interfere with daily activities. DBS is a neurosurgical procedure which uses implanted electrodes to deliver electric stimulation directly into specific parts of the brain responsible for symptoms like essential tremor, Parkinson’s disease or dystonia – and in certain cases reduce seizures associated with treatment-resistant epilepsy.
Prior to initiating DBS treatment, doctors conduct an intensive evaluation process in order to ensure it will meet your needs. A team of experts, such as a movement disorder specialist (a neurologist with extra training in Parkinson’s) and brain surgeon, reviews your medication regiment, tests memory and thinking abilities and conducts detailed brain imaging scans.
Our specialists at OHSU were among the first to pioneer “awake” DBS surgery, which allows you to remain awake during the procedure so you can respond to questions from your neurosurgeon and help place electrodes correctly. You will receive numbing medication to keep any pain or discomfort at bay; one of our unique advantages as an institution is having a speech pathologist by your bedside during this important step in care.
Once installed, DBS allows your neurologist to fine-tune its settings for maximum effectiveness. Furthermore, you can turn it off as needed; should no longer require DBS treatments during follow-up surgeries, leads and pulse generators can be removed in follow-up surgery sessions.
DBS may be used in combination with medications or physical therapy treatments. Depending on your condition and goals, DBS could enable you to reduce dosages or switch medications that produce fewer side effects.
Before making a decision about DBS, your healthcare provider will discuss both its advantages and drawbacks with you. In general, insurance will cover it if it has been officially approved as treatment for your condition.