Deep Brain Stimulation Procedure: A Deep Insight - Dr. Vikas Kathuria

Introductionr
Deep brain stimulation surgery is effective in managing the symptoms of essential tremor, epilepsy, Parkinson’s disease, and dystonia. The abnormal activity of the brain is managed through electrical impulses. In this procedure, the doctor inserts the electrode in the skull and is connected to the impulse generator that is placed in the chest.

Deep Brain Stimulationr
Deep brain stimulation surgery is the procedure for correcting movement disorders. The movement disorders are due to abnormal electrical activity in the brain tissues. This results in shaking of limbs, tremors, and difficulty in movement. Deep brain stimulation surgery helps in managing the abnormal electrical impulses in the brain. The surgery is used in preventing or reducing the symptoms of essential tremor, obsessive-compulsive disorder, epilepsy, Parkinson’s disease, and dystonia.

Deep brain stimulation surgery is a complex surgery. The surgeon performs the surgery in two places. The surgery involves the insertion of electrodes into specific target areas of the brain.

Procedure For Deep Brain Stimulationr
The first Deep brain stimulation surgery was done by Prof. Benabid. From then to now, much has been changed. The surgery of Deep brain stimulation occurs in few steps. The patients are advised to get admitted into the hospital a day before the surgery. The doctor evaluates the patient in great detail to determine his eligibility to undergo the procedure.

The patient undergoes Magnetic Resonance Imaging to identify the target area when the doctor inserts the electrodes. The place of insertion depends upon the type of condition. During the electrode insertion surgery, the patient is under local anaesthesia.

After the insertion of electrodes, the doctor gives one daybreak to the patient. The doctor fits the impulse generator below the clavicle, or in some cases in the abdominal cavity. The impulse generator and electrodes are connected with the help of a wire.

After the surgery is completed, the doctor sets the strength of impulse that travels from the generator to the electrodes. The patients may adjust the impulse strength anytime after the surgery.

Areas For Inserting Deep Brain Stimulationr
There are various areas for inserting the electrodes. The site of insertion depends upon the disease. The site will be different for essential tremor and Parkinson’s disease. The factors that decide the site include the most severe symptoms the patient is experiencing, the dose of levodopa the patient is taking, and the side effects of medications. Following are some of the areas of the brain for electrode insertion:

Globus pallidus internus: Insertion of electrodes in this area reduces the shaking movements. It helps in lowering the dosage of medications.
Subthalamic nucleus: Insertion in this part of the brain reduces the symptoms of Parkinson’s disease.
Pedunculopontine nucleus: Insertion of electrodes in this area causes gait freezing.
Thalamus: Inserting electrodes in the thalamus provides relief from tremor.
Thalamus and Pedunculopontine nucleus are not the preferred areas for electrode insertion.

Precautions After Deep Brain Stimulation Surgeryr
The patients should strictly follow all the instructions of the surgeon. Do not use heat during physical therapies. The device may interact with the high-voltage machines. So, stay away from these machines. While playing the contact sports while wearing this device, the patient should protect it from impact. The high impact may alter the functioning of the device.

Risk Factors Of Deep Brain Stimulation Surgeryr
Like other surgeries, deep brain stimulation surgery also has certain risks. These are:

Bleeding
Infection
Clotting
Seizuresr
Nausea and vomitingr
Vision, speech, and balancing problemsr
Headache
Confusionr
Light-headednessr
Stroker
Deep Brain Stimulation Surgery: Advantages And Clinical Resultsr
Following are some of the advantages of deep brain stimulation:

Effective: Deep brain stimulation is highly effective. People with this procedure experience a significant reduction in symptoms.

Reversible: Deep brain stimulation surgery is reversible. Once the patient does not need the device, the surgeon removes the electrodes from the brain and the impulse generator from the chest through another surgery.

Adjustable: The strength of the impulses can be adjusted according to the need of the patient. There is no need for revision surgery if the symptoms of the disease become more severe. The doctor, with the help of a remote, adjusts the strength of impulse.

Fewer side effects: The side effects of deep brain stimulation is fewer as compared to other invasive options.

Reduced medications dose: The patients with deep brain stimulation procedure require a low dose of medications. Lowering the dose reduces the overall side effects.

Various studies have been conducted to analyze the efficacy of deep brain stimulation. One study concludes that deep brain stimulation lowers the depression symptoms in obsessive-compulsive disorder. Another study concludes that the deep brain stimulation procedure reduces motor fluctuations and dyskinesia. The same study concludes that the need for dopaminergic activity was lowered by 54.5%.

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