Deep Brain Stimulation (DBS) for

When is Deep Brain Stimulation (DBS) indicated?

DBS is indicated in the management of essential tremor and dystonia in patients with parkinson’s disease and other movement disorders. The procedure is suitable for people who have had:

• Parkinson’s disease for at least four years
• Respond to parkinson’s disease medication but have developed motor complications over time
• Have intact cognitive functions
• No serious underlying systemic illness
• Have no signs of severe vascular disease, extensive atrophy, or signs of atypical parkinson’s disease in the MRI of the brain.

How is Deep Brain Stimulation (DBS) surgery performed?

Identifying the brain target: Before the procedure is done, the exact target brain areas where electrical nerve signals generate PD symptoms, are identified with the help of Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scanning or microelectrode scanning.

Surgery: The surgery involves two stages:

• First stage: Thin wires or electrodes are placed into the specific target area of the brain. The patient is kept awake to perform certain tasks to ensure that the electrodes are positioned correctly.
• Second stage: On the same day or next day,the electrodes are connected to a battery-operated device called impulse generator battery (IPG) or neurostimulator, by an insulated wire passing under the skin of the head, neck and shoulder. The neurostimulator is then implanted under the skin below the collarbone.

Programming: The IPG is turned on and adjusted 2-4 weeks after surgery and may take a few weeks before patients receive adequate symptom relief. The patient receives initial programming of the neurostimulator so that it delivers continuous electrical pulses through the electrodes. These impulses interfere with and block the electrical signals that cause PD symptoms. All parts of the stimulator system are located internally. Patients may also receive a hand held device to check battery and switch on and off the device.

What is the success rate of Deep Brain Stimulation (DBS)?

• Studies report that DBS can reduce off -periods PD symptoms by 60% (fluctuations in motor symptoms due to poor response to medicines).
• By reducing the need of medication, DBS rapidly decreases medication-induced dyskinesias by 60 to 80% and improves quality of life in people with advanced PD.
• DBS motor benefits have been reported to remain clinically evident for as long as 10 years.

What factors should be considered while choosing a hospital for Deep Brain Stimulation (DBS) surgery?

DBS is a major surgery and for the best possible outcomes, it is extremely important to choose a center with an expert team of neurosurgeon, neurologist, and health care team trained and experienced in DBS therapy. In addition to an expert surgical team, the hospital should have proper support infrastructure like intraoperative diagnostics, neurosurgery room (OT) and neuro intensive care unit (NICU) to fulfill the pre-operative and post-operative needs.