Deep Brain Stimulation

What are movement disorders?
Movement disorders refer to a group of neurological/nervous system conditions that cause abnormal increase in movements, which may be voluntary or involuntary. Movement disorders can also cause reduced or slow movements. The surgery used to treat such conditions is called Functional Neurosurgery. It involves the restoration of neurological condition, functions and treats chronic neurological disorders with a variety of techniques, including highly focused neuromodulation and deep brain stimulation.

This surgery is one of the most rapidly growing specializations in the field of neurosurgery and provides great hope for patients with previously untreatable neurological conditions. It is a safe and effective treatment for essential tremor, as well as tremor and involuntary movements associated with Ataxia, Parkinson’s disease, Dystonia, Myoclonus, Wilson’s disease and Tourette syndrome. It is used to manage some of the symptoms of Parkinson’s Disease that cannot be adequately controlled with medications.

Deep Brain Stimulation

Not all neurological disorders related to movement require surgery. Only after a proper evaluation by the doctor and tests can it be decided whether a person requires a surgery to correct any such movement disorders. Once it is found that there is no other option other than surgery, then the Deep Brain Stimulation technique can be used to treat such conditions. It is a technique used during a functional surgery to implant a device that sends electrical signals to areas of the brain responsible for body movement and to treat movement disorders. The device has electrodes, which are placed in the brain and are connected to a stimulator device. Just like a pacemaker, a neurostimulator uses electric pulses to regulate brain activity. In deep brain stimulation, the electrodes are placed in specific area of the brain depending on the symptoms that are being treated. The electrodes are placed on the two sides of the brain through small holes made at the top of the skull.

Deep brain stimulator is made up of the following parts:

• Neurostimulator – It is a programmable pacemaker device that creates electric pulses and has a battery. It is placed in the chest below the collarbone or in the abdomen under the skin.
• Lead – Is a coated wire with a number of electrodes at the tip that deliver electric pulses to the brain tissue. It is connected to an extension wire through a small hole in the skull.
• Extension – It is an insulated wire which connects the lead to the neurostimulator. It is placed under the skin and runs from the scalp, behind the ear, down the neck, and to the chest.
• Hand-held programmer device – It adjusts the device’s signals and can turn the device off and on easily.

Who requires a deep brain stimulation surgery?

Before being considered a candidate for deep brain stimulation (DBS), patients must undergo an extensive evaluation process. Ideally, a multidisciplinary team of specialists including a neurologist, neurosurgeon, neuropsychologist and psychiatrist will assess the patient.

If patients are well managed on medications, DBS is not considered. Candidates for DBS are generally patients who meet these criteria:

• Symptoms are not well controlled despite receiving the appropriate dose of medications.
• Symptoms are significantly reducing a patient’s quality of life.
• Side effects from current medications cannot be tolerated.

Risks of a Surgery

Deep brain stimulation is minimally invasive and safe but can have side effects. In Deep brain stimulation small holes are created in the skull to implant the electrodes, and surgery is done to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:

• Misplacement of lead
• Bleeding in the brain
• Stroke
• Infection
• Breathing problems
• Nausea
• Heart problems
• Seizure

How long does the battery in the impulse generator device last?

Batteries can last 3 to 5 years in non-rechargeable devices and up to 9 years in rechargeable battery devices. However, it may vary. A simple outpatient procedure is needed to replace the battery. Rechargeable battery devices can be charged for 30 minutes daily  or every 10 to 14 days for about 4 hours.

Possible side effects after surgery

Side effects of deep brain stimulation include:

• Seizures
• Infection
• Headache
• Confusion
• Difficulty in concentrating
• Stroke
• Hardware complications, such as an eroded lead wire
• Pain and swelling at the implant site

How should I care for the surgical area once I am home?

Once you are home, there are certain precautions and care to be taken like:

• The stitches/staples will be removed 10 to 14 days after surgery.
• Each of the 4 pin sites should be kept covered with band aids until they are dry. Change them daily as per requirement.
• Avoiding the surgical area and wash your head with a damp cloth
• Gently shampoo your hair the day after your stitches or staples are removed
• Do not scratch or irritate the wound areas.

Precautions to take after a brain stimulation surgery

• Refrain from housework and sexual activity for 2 weeks after surgery.
• Heavy and strenuous activities like jogging, swimming, or any physical education classes should be avoided to allow your surgical wound to heal properly and should be resumed only after 4 to 6 weeks of surgery.
• Do not lift weight more than 3 kg for at least 2 weeks
• You should not raise your arms above your shoulders or over bend or stretch your neck.
• Depending on the type of work you do, you may return to work within 4 to 6 weeks.