Introduction
USFDA has approved the DBS procedure in various movement disorders such as epilepsy, Parkinson’s disease, dystonia, and obsessive-compulsive disorder. It is effective and improves quality of life.

What Is Deep Brain Stimulation Procedure?
DBS procedure helps in managing the symptoms of movement disorders. The surgeon inserts the electrodes in the brain, and the impulse generator creates impulses. These electrical impulses help in managing the abnormal activity inside the brain.

When Doctor Recommends Deep Brain Stimulation Procedure?
Doctors perform Deep Brain Stimulation in patients with movement disorders such as Parkinson’s disease. It is a progressive condition. During the initial period of the disease, medications can manage the symptoms. The side effects of medicines outweigh the clinical efficacy. However, as the disease progresses, the medicines are no longer able to control the symptoms. Increasing the dose increases the side effects without much increase in efficacy. Every change in treatment strategy is short-lived, and the quality of life is significantly impaired. In such cases, the doctor recommends undergoing deep brain stimulation surgery.

The effect of medications usually starts fading 6-7 years after diagnosis of Parkinson’s disease. People with early-onset Parkinson’s disease have more difficulty controlling the symptoms with medicines as the disease progresses.

What Are The Benefits Of Deep Brain Stimulation Procedure?
The deep Brain Stimulation procedure has the following advantages:

Efficacy: DBS procedure is effective in most patients with Parkinson’s disease. They experience improvement in the quality of life.

Reducing the dose of medications: Medications of Parkinson’s disease have side effects. An increase in dose, as the disease progresses, increases side effects. With deep brain stimulation procedure, there is a need for a low dose of medications. It results in a decrease in medication-induced side effects.

Management of symptoms: DBS helps in managing various symptoms related to Parkinson’s disease. These are reducing hallucinations and dyskinesia, managing depression regulates movements, and improves the overall quality of life.

Reduction in the OFF period: OFF period in Parkinson’s disease is the returning of symptoms due to the non-efficacy of medications. It may occur for some time during the day. With the DBS procedure, the patient is in ON time for approximately 80% of the day. There is a significant decrease in OFF time.

What Is The Procedure For Deep Brain Stimulation Surgery?
Deep brain stimulation surgery involves placing the deep brain stimulation device. The deep brain stimulation device comprises three parts. These are impulse generator, extension wire, and electrodes. The doctor inserts the electrodes in the specific part of the brain and fits the impulse generator in the chest area just below the clavicle. The patient undergoes surgery under either general or local anaesthesia.

What Are The Complications Of Deep Brain Stimulation Surgery?
Deep Brain Stimulation surgery is complex. The procedural complications depend upon various factors, including the facilities and infrastructure and the surgeon’s experience. It may have the following complications:

Infection
Seizures
Blood clot
Bleeding
Vertigo
The overall risk of complication is low, and most patients have positive outcome post-surgery.

How Is The Recovery After Deep Brain Stimulation Procedure?
As the surgery is complex and involves the brain, you should take good care of yourself after the surgery and follow the doctor’s instruction. The doctor will discharge you within 1-2 days after the surgery. Avoid performing any light activity within 1-2 week after the surgery. Do not perform heavy activities such as lifting the weight with 4-6 weeks post-surgery. Avoid stretching of shoulders or neck. You may return to work 4-6 weeks after the surgery.

Why Surgeons Perform Deep Brain Stimulation Procedure In Two Steps?
The surgeons find it safer to perform DBS in two stages. In the first stage, the doctor performs the surgery under local anaesthesia and shifts the patient to the ICU to allow the patient to take medications. The surgeons conduct the second phase of surgery the next day under general anaesthesia.

Is Deep Brain Stimulation Surgery Painful?
Doctors generally perform the surgery through local anaesthesia. The patient only feels pain when the surgeon injects the anaesthesia. Once there is the effect of anaesthesia, the patient does not feel any pain. The doctor keeps discussing the patient during the surgery to infuse confidence in the patient.

Is Deep Brain Stimulation Surgery Not Advisable To Elderly?
There is no problem with the DBS procedure in the elderly. The doctor performs a health evaluation of the patient to determine his eligibility. However, many surgeons do not advise the elderly to undergo DBS procedure as they are not convinced about the surgical outcome and recovery. However, various cases have indicated that the elderly may also undergo DBS procedure without any complications.

Is Programming Required In Deep Brain Stimulation?
It is important to note that the DBS procedure does not cure Parkinson’s disease. The doctor advises this surgery to manage the symptoms. The patient should visit the surgeon once in the first three months for programming of the pulse output. The doctor adjusts the electrical impulse according to the need of the patient.

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Author's Bio: 

Dr. Vikas Kathuria is a neurosurgeon and spine surgeon in Gurgaon, Haryana. He specialises in Brain Tumor Surgery, Deep brain stimulation, Spine surgery, Brain Hemorrhage treatment and Head Injury treatment in gurgaon, rohtak, faridabad and sonipat.