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Deep Brain Stimulation Treatment for Neurological Disorders

March 25, 2021

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How can Deep Brain Stimulation treatment address neurological disorders?

The Food and Drug Administration has approved deep brain stimulation for the treatment of numerous movement and neurologic disorders, including:

Parkinson’s disease
Dystonia
Essential tremor
Epilepsy
Obsessive-compulsive disorder (OCD)

Deep brain stimulation is now being investigated as a treatment option for the following conditions:

Multiple sclerosis (MS) is a condition that is caused by an allergic reaction. When you have these conditions, the immune system kills healthy cells by accident.
Depression is a psychological disorder that impairs your adaptability to respond and affects your mood.
The Traumatic brain is caused by a variety of factors, including falls and car crashes (TBIs). When you suffer a major head injury, your brain clashes against your skull.
Addiction includes the obligation of excess items like medications or food. Addictions are dangerous to those who have them, and to their family members cause suffering and misery.
Chronic pain occurs in all areas of the body and lasts months or years. It interferes with everyday life and can cause psychological distress like depression and anxiety.
Stroke normally occurs whenever a blood vessel is blocked or exploded in the brain.
Thalamic pain syndrome or central post-stroke pain may occur if one of the brain circuits is disrupted and reduces the temperature sense.
Alzheimer’s disease is an unstoppable brain condition. The disorder inhibits the ability of an individual to conduct simple day-to-day tasks seriously, including memories, thought, learning, and organization.
Anorexia nervosa is most often found in teens and young adult women, but also in males and in infants and older people.
Tourette syndrome is a condition that causes unregulated movements and vocal sounds such as tics. It also occurs at a young age and increases in adulthood

Who’s a deep brain stimulation surgical candidate?

Patients must be thoroughly evaluated before they are considered a candidate for deep brain stimulation (DBS). The patient hopefully will be evaluated by a multidisciplinary team including a neurologist, neurochirurge, neuroscientist, and psychiatrist.

DBS is not taken into account as patients are well administered in prescriptions. DBS applicants are usually patients who fulfill the following requirements:

Despite getting the required dosage of medication, the symptoms are not well managed.
Symptoms substantially lower the quality of life of a patient.
Present medicines can’t tolerate side effects.

How does fundamental brain stimulation work?

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A stereotactic head frame is placed over your head before the real operation starts and will hold the head steady during brain imaging. Surgical pins or screws are applied to lock the head against the door.

The deep brain stimulation device will be implanted within two steps by your neurosurgeon:

First, A small hole is drilled into the skull. The electrode-tipped leads are inserted into this opening and surgically inserted in the parts of the brain that have been identified as parts leading to the symptoms.

A lead is placed on one side of the brain until signs on either side of the body arise (then one lead is positioned on each side of the brain). Each part of the brain (hemisphere) regulates the opposite side of the body so that each part of the brain is inserted on the other side of the body.

Approximately 1 week after, one or two battery-driven Pulses (one on a lead) are inserted in your upper chest below your collarbone, immediately below the skin. The lead that is already located in your brain is hooked to an extension wire and then tuned to the pulse generator system under your skin after your ear and neck.

After your implant surgery, you can report to your office about 2-4 weeks later. A manually controlled interface activates the embedded pulse generator and adjusts the electrical pulses until symptoms improve. (The computer transmits electrical waves along these lines to the brain.) The handheld unit will also monitor the level of the battery and can toggle the unit on and off.

Remember- Various programming follow-up visits may be needed if the stimulus to the brain is to be improved to alleviate the symptoms. Long-term follow-up appointments are then arranged periodically to continue in order to ensure the machine works correctly, change the stimulus if necessary so that effects continue to be optimized and battery lives checked.

How does the neurosurgeon decide where electrodes can be placed in the brain?

It is the most crucial step to place the electrodes in the brain. In order to enhance symptoms, the electrodes should be located precisely in the brain. Before and/or after the treatment, computed tomography (CT) or magnetic resonance imaging (MRI) scans are taken to determine the precise targeting areas and to direct the location of lead and electrodes. An electrode may also be used to record brain cell activation at the target location to enhance the lead positioning.

What is the malfunctioning of the DBS?

The most popular malfunction of an embedded DBS is the spread of electric current from the field we want to concentrate on other areas. For instance, spreading the current to centers can trigger blurred vision rather than better tremors. The big benefit of DBS over pallidotomy is that on each DBS electrode there are four touchpoints (one on each side of the brain). We may select one of these points of touch if it has side effects.

In most cases, we will consider the sweet-spot electrode which controls symptoms with the lowest side effects to the best extent. The breakage of lead is indeed an unusual malfunction. If it does, the DBS loses its effect and symptoms will return. The battery wears down, and the symptoms return after only 3 or five years. The battery replacement is a relatively easy outpatient operation. Approximately 5 percent infection may occur. This will most commonly be managed with antibiotics but the DBS must be eliminated in some cases.

What are deep brain stimulation (DBS) risks and complications?

There are risks and complications as in any surgical operation

DBS complications are grouped into three types:

Surgery complications
Hardware complications (devices and wires)
Complications linked to Stimulation

Surgical complications include brain hemorrhage, brain infection, incorrect positioning (movement) of the DBS leads, and less than the best positioning of leads.

Hardware complications include lead motions, lead loss, DBS device failure on any component, pain on the pulse generator, battery failure, skin-break infection as the thickness of the skin and fat layer varies as you grow older.

Complications associated with stimulation arise during the programming stage of any patient. Unintended motions (dyskinesia), freezing (feet feeling frozen to the ground), deterioration of posture and gait, voice disruption, unintentional muscle contractures, stubbornness and tingling (paresthesis) and dual vision are common side effects (diplopia). The modified device reverses these side effects.

Bottom Line

Deep brain stimulation can not cure the illness, but it does help to reduce symptoms. Deep brain stimulation works and greatly improves the symptoms, but usually doesn’t totally disappear. Drugs can also be necessary for some disorders in some circumstances.

For everyone, deep brain stimulation is not effective. The effectiveness of deep brain stimulation involves a variety of factors. Before surgery, it is important to speak to your doctor about the kind of change your condition might have.