What is deep brain stimulation (DBS)?
Deep Brain Stimulation (DBS) is a medical procedure in which a mild electrical current is sent to a specific part of your body.Brain. The electricity in this current stimulates the brain cells in that area, which can help with various medical conditions. The current reaches your brain through one or more wires connected to a small device implanted under the skin near your clavicle.
Who needs deep brain stimulation?
DBS treats conditions that affect the way your neurons, a key type of brain cell, do their jobs. When neurons don't work properly, it affects the abilities that those neurons control. Depending on the severity of the problem, they may lose some or all of these abilities.
Why is DBS used?
There are billions of neurons in every human brain, and these cells communicate with each other through electrical and chemical signals. Various brain disorders can cause neurons in different parts of your brain to be less active. When that happens, those parts of your brain don't work as well. Depending on which part of the brain is affected, the controlled abilities in that area may be affected.
DBS uses an artificial electrical current to make these neurons more active, which can help with symptoms of various brain disorders. However, researchers still don't know exactly how and why this works.
What diseases and symptoms can DBS treat?
DBS can treat a number of conditions that affect your brain, including movement disorders, mental illness, and epilepsy.
DBS is approved by the US Food and Drug Administration to treat the following conditions:
- essential tremors.
- drug resistantEpilepsy.
- Parkinson's disease(if this condition worsens and the medicines are not as effective).
- drug resistantObsessive Compulsive Disorder (OCD).
Conditions that could benefit from DBS
Researchers are also studying whether or not DBS may help with other conditions. Conditions that could benefit from DBS include:
- Alzheimer disease.
- Terrible headache.
- eating disorder.
- Severe pain disorders (particularly pain that occurs due to nerve or brain disorders, or pain due to incurable diseases such asKrebs).
- heavy, drug resistantDepression.
- Tourette syndrome.
It's important to note that while the above conditions could benefit from DBS, experts don't yet know if this is the case. It usually takes years of research and clinical trials to determine if a medical procedure like DBS is helpful in such conditions. As researchers study them, DBS surgery is not common to treat these conditions.
How common are DBS implantation procedures?
Experts estimate that, as of 2019, around 160,000 people have undergone a DBS device implantation procedure since the 1980s. Experts also estimate that around 12,000 procedures are performed each year.
What happens before deep brain stimulation (DBS)?
Before this procedure, your healthcare provider will discuss the advantages and disadvantages of implanting a DBS device. They will also explain the possible risks involved in this surgery. They will also check to see if you can have this surgery, which may include other imaging scans or lab tests to look for reasons why you can't have the procedure.
If you decide to have a DBS implant anyway, your provider will provide you with detailed informationMagnetic Resonance Imaging (MRI)yComputed Tomography (CT)Scans of your brain. These scans will help your provider decide which site is the best place to run the cables for the DBS.
Before the procedure, your provider will also talk with you about the following:
- Medications you are taking:Before your procedure, your doctor may ask you to stop taking some medications (such as blood thinners). You should only stop taking medication after consulting your doctor. If you have questions about the medications you're taking (including vitamins and supplements), it's a good idea to ask your doctor about them during these discussions.
- Bath and care:Your doctor will likely give you instructions on how to bathe and prepare for the procedure. This usually includes a special shampoo or other products to prepare the skin for the procedure.
- Hold:Because this operation involves generalanesthesia, your healthcare provider will have it fast. That means not eating solid food for at least eight hours before the procedure and not drinking liquids for at least two hours before.
What about deep brain stimulation (DBS)?
This procedure actually involves two to three surgeries that are usually done at different times. The first procedure or two involves inserting the stimulation wires into both sides of your brain at the same time or at different times. The second procedure involves implanting the stimulator's battery, known as a pulse generator, under the skin of the upper chest.
Before these surgeries are done, your doctor will usually insert an intravenous (IV) line to give youintravenous fluids. An IV also allows them to give you medication if needed during the procedure.
placement of prospects
This procedure usually begins with your doctor shaving the hairs from your scalp. This makes it easier to rest your head on a special frame that keeps your head steady. The frame is attached to his skull with four pins. This happens while you're sedated and you probably won't remember that part.
Once the framework is established, they bring in an intraoperative CT scanner to capture images of your brain and identify the trajectory used for electrode placement. Once the CT scan is complete, the entry point will be identified, sedation will be reactivated, and the head will be cleaned with surgical dressings. A local anesthetic is then injected to numb this area of your scalp and skull. YourneurosurgeryHe will then make a small cut (incision).
After the incision, a surgical drill is used to make a small opening in the skull to insert the electrodes. Depending on the reason for the operation, you may be awakened for an activation test. This happens mainly with movement disorders. If you are awake, you may feel the vibrations or hear a drilling noise, but you should not feel any pain from it. Your brain also can't feel pain directly, so you won't feel pain when the neurosurgeon inserts the electrodes.
As the neurosurgeon places the electrodes, you must answer questions, read or look at images, or move your arms, legs, hands, and feet in specific ways. So they can be sure that potential customers are in the right place. They will also do another CT scan to make sure the electrode placement is correct.
The number of leads and their placement depends on your case. Some people may only have one duct, while others may have multiple ducts on one or both sides of their head. Once the electrodes are placed, the ends of the electrodes are protected by a plastic cap and inserted under the skin to the back of the head. The incisions are then cleaned and closed.
You will go to recovery, where a CT scan will be done to confirm the placement of the electrodes and make sure there is no blood. They spend one night in the hospital for observation, and most people go home the next day.
Pulse Generator Placement
The second procedure, surgery to implant the pulse generator, is usually done at a later date. This procedure involves general anesthesia, which means you'll be asleep so you won't feel pain or discomfort during the surgery.
Your surgeon will make a small incision in the skin just under the skin.clavicleduring this process. It then creates a small bag-like space under the skin to hold the pulse generator. They will then insert an extension cord that runs between the outside of your skull and the underside of your skin.
Let the cable travel down until the other end is under the skin near the clavicle in the battery pocket. Then, connect the extension leads to the DBS electrodes and the other end of the extension lead to the pulse generator. It is then placed in the bag-like space under the skin before it is sewn on. You go home the same day.
What happens after deep brain stimulation (DBS)?
Your healthcare provider will schedule a follow-up appointment within a few weeks of device implantation. At this appointment, they begin to program the pulse generator.
All pulse generators currently in use have a built-in wireless antenna. This allows your healthcare provider to access and program the device from outside your body. Finding the correct pulse generator setting can take time and additional visits for adjustments.
Most pulse generators have special long-life batteries. Standard batteries for these devices last three to five years. Some devices use rechargeable batteries that can last around nine years. Replacing the battery also requires surgery, but it is generally shorter and faster than the original surgery to implant the pulse generator. You will go home the same day to replace the battery.
Risks / Benefits
What are the benefits of Deep Brain Stimulation (DBS)?
DBS has several advantages. These include:
- You can offer a treatment option when medications do not help:DBS is an option when medications don't work or have stopped working. For Parkinson's disease, medications become less effective over time, so your doctor may need to increase your dose. This leads to other side effects. With DBS, lower doses of medication often work again, meaning your symptoms are under control and there are fewer side effects.
- It can be a life-changing (or even life-saving) treatment:Some of the conditions that DBS treats can have serious effects that prevent you from doing even the most routine activities. DBS can treat your condition and improve your symptoms, improving your overall quality of life. For conditions like drug-resistant epilepsy where surgical resection is not an option, DBS can offer hope and relief.seizureFrequency.
- It is adjustable:Your healthcare provider can adjust the pulse generator settings to find what works best for you.
- es reversible:Follow-up surgery can remove the electrodes and pulse generator if DBS doesn't work or causes side effects you can't tolerate.
What are the risks or complications of DBS?
Because DBS requires surgery, there are some potential complications and risks. Your doctor is the best person to educate you about the possible risks and complications. They are the best source of information because they can take into account your medical history, circumstances, and more.
Possible complications of surgery include:
- infections etcSepticemia.
- bleeding (internal or at the site of your incisions).
- To come.
- swelling in and around your brain.
Some complications can arise due to the electrodes and the pulse generator. These include:
- Displacement or loss of cables.
- The connecting leads are separated from the pulse generator.
- Leads or pulse generator failure.
- Pain or discomfort around the pulse generator.
Pulse Generator Programming and DBS Side Effects
DBS uses electrical current to stimulate areas of your brain. This current almost always needs to be adjusted and tuned before it will have the best possible effects. This means that the following symptoms are common while your healthcare provider is working on programming the pulse generator:
- balance problems.
- Confusion or difficulty concentrating.
- double vision (diplopia).
- memory problems
- numbness and tinglingin certain parts of your body.
- Unexpected changes in brain function that can affect your body (sudden weakness or problems with muscle control in a specific part of your body).
Recovery and Outlook
What is the recovery time?
Your health care provider is the best person to tell you what to expect regarding your recovery time and when you will notice changes in your symptoms and condition. They can tell you how long it will likely take you to recover, which may depend on other factors, such as your general health, other medical conditions, and your personal circumstances.
Most people need to stay in the hospital for a day after surgery to have the DBS electrodes implanted in their brain. Surgery to implant the pulse generator is usually a same-day return-home procedure.
In general, the recovery time usually lasts several weeks. Your healthcare provider will likely ask you to do the following:
- Avoid any type of activity for about two weeks after each procedure:This includes things as trivial as housework or sexual activity. You must not lift anything that weighs more than 5 pounds.
- Avoid moderate to vigorous intensity activities for at least four to six weeks:This includes exercise and physical labor. Most people can return to work or their usual routine afterward.
- Be careful when moving or stretching:For a few days after the surgery to implant the pulse generator, you should avoid certain movements, e.g. B. Raise hands above head. Your doctor will tell you how long you need to limit your movements.
How should I care for the surgical site when I am at home?
Your health care provider will give you instructions on how to care for the operated areas. In general, you should do the following (unless otherwise stated):
- About 10 to 14 days after surgery, your provider will remove any sutures or staples you have.
- Head nail sites should remain covered with bandages until dry. Also, you should change bandages at least once a day (or as directed by your doctor).
- The bandage can be removed two days after the operation.
- At this point you can take a shower, just let the water run over your head and don't scratch it.
- You can use shampoo on your hair as long as it is baby shampoo. You have to be very gentle when doing this. To dry your head, pat the area very gently, but don't rub.
- Do not scratch the area around your incision. This can damage the wound and cause an infection.
When to call the doctor
When should I see my doctor?
Your health care provider will schedule visits to see you after your procedures. Scheduling visits take place at your home.neurologist, and you need to make appointments to see them. The goal of these visits is to find the setting that works best and does not cause life-interrupting side effects.
Regular visits to your doctor are also common to monitor your condition and symptoms and adjust medications or other treatments as needed. Your provider will discuss the schedule of these visits with you.
When should I call my doctor or go to the hospital?
Since DBS involves surgery, specifically surgery on your brain, there are some warning signs you shouldn't ignore. You should call your doctor immediately or go to the hospital outside of business hours if you have the following symptoms:
- Difficultheadachethis happens suddenly or does not go away.
- bleeding from your incisions.
- Unusual redness, swelling, or warmth, which are signs of infection, around the incisions.
- sudden changes in yourVision, such as B. Double vision, blurred vision, or loss of vision.
- Fever101 degrees F (38.3 degrees C) or higher.
What is the success rate of deep brain stimulation?
In general, deep brain stimulation is usually successful. The success rate depends on the specific condition. In conditions like epilepsy and Parkinson's, DBS is very effective. More research is needed for the conditions in which DBS is experimental before experts know if DBS is likely to help.
Can I use electrical and electronic devices if I have DBS devices implanted?
In general, electronic gadgets and devices should not cause problems with the pulse generator. If this is the case, the most likely result is that your pulse generator shuts down. This may not have an immediate effect, but sometimes you will find your symptoms worsen or you will experience an uncomfortable feeling or feeling.
In general, you should consider the following:
- Your healthcare provider will provide you with two important items to keep on hand whenever possible: an ID card and a patient scheduler. The ID card can help you in situations involving certain types of electronic devices, such as metal detectors or anti-theft scanners. The patient programmer allows you to turn the device on and off and adjust pacing settings as needed.
- Household appliances, such as microwave ovens, computers, smartphones, and other common electronic devices, should not cause interference or problems with your pulse generator.
- If you have one or more DBS electrodes and a pulse generator implanted in your body, you cannot perform certain medical and imaging tests. The procedures you cannot undergo are MRIs,Transcranial Magnetic Stimulationy diatermia.
Does deep brain stimulation cure the conditions for which it is used?
No, DBS does not cure the diseases it treats. While it treats the symptoms, virtually all of the conditions it treats are lifelong and have no cure.
Do I still need to take medicine after deep brain stimulation?
Depending on the condition, it may be possible to reduce the medication. However, DBS is most useful when used in conjunction with medications and other treatments. This is because using it at the same time as other treatments means potentially reducing drug doses, experiencing fewer side effects, and still getting the same benefits.
Does insurance cover deep brain stimulation?
Many insurance companies will cover DBS, especially if they are officially approved to treat the condition. (In the United States, the US Food and Drug Administration is the agency responsible for approving these uses.) It is important to check with your insurance company to see if they have any coverage for DBS procedures.
A note from the Cleveland Clinic
Deep brain stimulation (DBS) is a treatment option that can help with a variety of conditions that affect brain function and mental health. It is almost always an option after other treatments and methods have failed. It's most common in conditions like Parkinson's disease and epilepsy, but researchers are looking into using it to treat many other conditions as well. Although it requires two to three surgeries, it is also very effective in relieving symptoms and treating conditions that severely affect your quality of life.