Deep Brain Stimulation
Deep brain stimulation also called (DBS) is a way for people with a movement disorder to decrease as much undesired movements as possible. DBS was approved by the FDA in 1997 for tremors, in 2002 it was made available for patients with Parkinson’s disease, and in 2003 the treatment was expanded to people with dystonia and other movement disorders. Since this is a pretty new practice of medicine, the results of patients are measured and are used to further advance this practice. DBS helps these movement disorders by sending electric stimulating pulses deep into to brain, helping to control the stimulations that travel through the brain to the rest of the body, which controls every movement a person makes.
Deep brain stimulation is usually done in two separate surgical procedures. In the first of these, the patient is totally wake and responsive. During this surgery, the patient is given local anaesthesia to numb the head. A halo is screwed into the patient’s head. This metal ring is then screwed to the OR chair. This prevents the patient’s head from moving in anyway. The basics of this surgery is to first drill a hole into the patient’s skull and then insert the stimulating lead down into the patient’s brain. The surgeons have to determine the best place the insert the lead into the brain. A MRI helps locate and map out, the best possible angle for the lead to be inserted into the patient’s brain. While in surgery the surgeon finds the best depth for the lead and screws the electrode in place and tucks the extra wire between the patient’s skull and scalp. The doctors turn on the stimulator to make sure they receive a response from the patient, letting them know they have everything perfect. If everything in the surgery goes correctly, the patient will be released from the hospital the morning after the surgery. The patient is monitored overnight to make sure there are no neurological problems related to the surgery.
The second surgery is much less dangerous and is done in an outpatient procedure. The surgeon has the patient put under general anaesthesia, so the patient is asleep for the length of the surgery. The doctor next takes the wire connected to the electrode and runs it behind the patients ear and down behind the collarbone. There is a battery that is connected to the wire and it is placed under the collarbone. The battery is what sends the electric pulse to the brain. In recovery the doctor sets the device to low settings so the voltage is pretty minimum.
One battery and one electrode only affect one side of the body because the two different sides of our brain each control the opposite side of our body. So if the electrode is planted in the right side of a patient’s brain, the left side of the body is affected by the stimulation. The technique for the timing of when to do these surgeries varies between doctors and patient. Doctors can implant two electrodes, one on each side of the brain, at once and then put in both batteries a week or two later or they can decide to see if they get any benefit from one side before they do the opposite side at a later date. Doing the surgeries one at a time lowers the risks of complications with the surgeries. Then the batteries would also have to be put into the patient’s body on two different dates.
After a week or so of having the battery tied in with the electrode, the patient returns to the doctor to receive programming. This programming is done to find the best setting for the patient. The settings of the stimulator can be changed and adjusted with a wireless external controller. The doctor can change the voltage amplitude, the frequency and pulse width of the stimulator. The stimulator on each electrode has four different contact points where the stimulation can be sent to. The stimulator can be set either to a single contact point or to two contact points. When the current is sent to dual contact points one sends out a positive stimulation and the other sends out a negative pulse. This makes the pulse half way between both contact points because the positive and negative pulse attract. Several programming sessions are needed to optimize therapy for each patient and may take up to six months to finalize the programming settings. Over time, as the disease progresses, the stimulation continues to control tremor, stiffness and slowness. After the programmer finds the best settings for a patient the only further medical treatment is the replacement of the battery. Depending on the settings of the stimulator the battery life is between 2-5 years.
There are some complications and risks with going in to the brain surgery. One of the biggest worries for this surgery is the risk of a patient’s speech getting worse, which is about a 3% risk. Another risk is infection which most likely would require the removal of the DBS hardware and another surgery. As with any of the best technology mankind comes up with, the hardware can stop working correctly. The electrode can get dislodged and move. These risks are very rare and with the benefits high, most patient’s trust in the doctors to give them a better life. As with most medical procedures younger patient have a lower risk of complications then older patients
Most patients see some difference in their movement ability immediately. Patients with Parkinsonism can expect a great, positive, change in movement control immediately. People with dystonia and other movement disorders may not see immediate or drastic results. With dystonia there is a much slower progression of improvement to movement control and with time DBS can extremely helpful for every move a patient makes. DBS surgeries also are starting to be found beneficial to people who have OCD and other mental disorders.
Deep brain stimulation also called (DBS) is a way for people with a movement disorder to decrease as much undesired movements as possible. DBS was approved by the FDA in 1997 for tremors, in 2002 it was made available for patients with Parkinson’s disease, and in 2003 the treatment was expanded to people with dystonia and other movement disorders. Since this is a pretty new practice of medicine, the results of patients are measured and are used to further advance this practice. DBS helps these movement disorders by sending electric stimulating pulses deep into to brain, helping to control the stimulations that travel through the brain to the rest of the body, which controls every movement a person makes.
Deep brain stimulation is usually done in two separate surgical procedures. In the first of these, the patient is totally wake and responsive. During this surgery, the patient is given local anaesthesia to numb the head. A halo is screwed into the patient’s head. This metal ring is then screwed to the OR chair. This prevents the patient’s head from moving in anyway. The basics of this surgery is to first drill a hole into the patient’s skull and then insert the stimulating lead down into the patient’s brain. The surgeons have to determine the best place the insert the lead into the brain. A MRI helps locate and map out, the best possible angle for the lead to be inserted into the patient’s brain. While in surgery the surgeon finds the best depth for the lead and screws the electrode in place and tucks the extra wire between the patient’s skull and scalp. The doctors turn on the stimulator to make sure they receive a response from the patient, letting them know they have everything perfect. If everything in the surgery goes correctly, the patient will be released from the hospital the morning after the surgery. The patient is monitored overnight to make sure there are no neurological problems related to the surgery.
The second surgery is much less dangerous and is done in an outpatient procedure. The surgeon has the patient put under general anaesthesia, so the patient is asleep for the length of the surgery. The doctor next takes the wire connected to the electrode and runs it behind the patients ear and down behind the collarbone. There is a battery that is connected to the wire and it is placed under the collarbone. The battery is what sends the electric pulse to the brain. In recovery the doctor sets the device to low settings so the voltage is pretty minimum.
One battery and one electrode only affect one side of the body because the two different sides of our brain each control the opposite side of our body. So if the electrode is planted in the right side of a patient’s brain, the left side of the body is affected by the stimulation. The technique for the timing of when to do these surgeries varies between doctors and patient. Doctors can implant two electrodes, one on each side of the brain, at once and then put in both batteries a week or two later or they can decide to see if they get any benefit from one side before they do the opposite side at a later date. Doing the surgeries one at a time lowers the risks of complications with the surgeries. Then the batteries would also have to be put into the patient’s body on two different dates.
After a week or so of having the battery tied in with the electrode, the patient returns to the doctor to receive programming. This programming is done to find the best setting for the patient. The settings of the stimulator can be changed and adjusted with a wireless external controller. The doctor can change the voltage amplitude, the frequency and pulse width of the stimulator. The stimulator on each electrode has four different contact points where the stimulation can be sent to. The stimulator can be set either to a single contact point or to two contact points. When the current is sent to dual contact points one sends out a positive stimulation and the other sends out a negative pulse. This makes the pulse half way between both contact points because the positive and negative pulse attract. Several programming sessions are needed to optimize therapy for each patient and may take up to six months to finalize the programming settings. Over time, as the disease progresses, the stimulation continues to control tremor, stiffness and slowness. After the programmer finds the best settings for a patient the only further medical treatment is the replacement of the battery. Depending on the settings of the stimulator the battery life is between 2-5 years.
There are some complications and risks with going in to the brain surgery. One of the biggest worries for this surgery is the risk of a patient’s speech getting worse, which is about a 3% risk. Another risk is infection which most likely would require the removal of the DBS hardware and another surgery. As with any of the best technology mankind comes up with, the hardware can stop working correctly. The electrode can get dislodged and move. These risks are very rare and with the benefits high, most patient’s trust in the doctors to give them a better life. As with most medical procedures younger patient have a lower risk of complications then older patients
Most patients see some difference in their movement ability immediately. Patients with Parkinsonism can expect a great, positive, change in movement control immediately. People with dystonia and other movement disorders may not see immediate or drastic results. With dystonia there is a much slower progression of improvement to movement control and with time DBS can extremely helpful for every move a patient makes. DBS surgeries also are starting to be found beneficial to people who have OCD and other mental disorders.
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