Deep Brain Stimulation
Deep brain stimulation is a way to inactivate the parts of the brain
that cause Parkinsons, the thalamus or globus pallidus, without
purposefully destroying the brain. In deep brain stimulation,
electrodes are placed in the thalamus (for essential tremor and
multiple sclerosis) or in the globus pallidus (for Parkinson's
disease).
The electrodes are connected by wires to a type of pacemaker
device (called an impulse generator, or IPG) implanted under the
skin of the chest, below the collarbone. Once activated, the
device sends continuous electrical pulses to the target areas in
the brain, blocking the impulses that cause tremors. This has
the same effect as thalamotomy or pallidotomy surgeries without actually destroying parts of
the brain.
The IPG can easily be programmed using a computer that sends
radio signals to the device. Patients are given special magnets
so they can externally turn the IPG on or off.
Depending on use, the stimulators may last three to five
years. IPG replacement procedure is relatively simple.
The stimulation can be turned on or off by the patient with a
hand-held magnet or an access control device.
How Does It Work?
Experts are unclear how deep brain stimulation works.
How Is DBS Performed?
Patients who are having stimulators placed on both sides of
the brain will have their surgery divided into two parts. Most
people with Parkinson's disease will require the surgery be done
on both sides of the brain. During the first surgery, the
electrodes are placed into the brain, but left unconnected.
There are several ways in which the electrodes are placed
into the target areas of the brain. First these areas must be
located. One way to locate the target areas is to rely only on
a computed tomography (CT) or magnetic resonance imaging (MRI) scan. While some surgeons
stop there, others use an electrode recording technique to map
and target the specific areas that they will need to reach.
Once the correct location is identified, the permanent
electrodes are implanted. The loose ends are placed underneath
the skin of the head and the incision is closed with sutures.
One week later, the patient is readmitted to the hospital for a
very brief time. The patient is placed under general anesthesia
and the extension wires are disconnected from the loose ends of
the electrodes and then connected to the impulse generators. Two
to four weeks later, the IPG is turned on and adjusted. It may
take a few weeks until the simulators and medications are
adjusted sufficiently for patients receive adequate symptom
relief. But, DBS causes very few side effects.
What Is Subthalamic Nucleus DBS?
Subthalamic Nucleus Stimulation is a new application of the
original DBS technique. After extensive clinical trials,
stimulation of the subthalamic nucleus has been recognized as
the most effective surgical treatment for Parkinson's disease,
addressing not only tremors, but the full range of the disease's
symptoms, including: rigidity, slowness of movement, stiffness,
and walking concerns.
Successful stimulation of the subthalamic nucleus allows
patients to consistently reduce their medication while improving
all of their other disease-related symptoms. In addition, the
surgery to place the stimulator in the subthalamic nucleus is
generally easier than surgeries for the thalamus or globus
pallidus.
Next: What are the advantages of deep brain stimulation? »
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