Mind and Body

What is deep brain stimulation?

Deep Brain Stimulation (DBS) is an important procedure used to treat a wide range of neurological disorders. To help you understand this surgery, here is a guide to the basics of deep brain stimulation:

What DBS treats
DBS is currently considered an established treatment for Parkinson’s disease and essential tremor, a neurological movement disorder. Standard treatment therapies for these disorders usually begin with medication, while DBS is only used if the medications are inadequately effective. The Food and Drug Administration (FDA) has also approved DBS as a treatment for obsessive compulsive disorder.

Dr. Joshua Rosenow, director of functional neurosurgery at Northwestern Memorial Hospital, says that DBS will be used to treat more conditions in the future. “We are currently in the process of exploring this for psychiatric disease (OCD,  Tourette’s, depression), Alzheimer’s, epilepsy, addiction, and multiple other conditions,” explains Hunt, ”Improvements in DBS technology combined with further knowledge of the circuitry of these disorders will allow us to greatly expand what we do.”

The procedure
DBS alleviates debilitating neurological symptoms by administering electrical impulses to designated areas of the brain. The procedure primarily centers around three implants: the neurostimulator, the extension and the electrode. To prepare for the procedure, surgeons will generate a map of your brain with magnetic resonance imaging (MRI) or computed tomography (CT) scanning. This map can help the doctor determine where to send the electrical impulses. During the procedure, the surgeon implants a neurostimulator into your body–usually around the collarbone. The neurostimulator functions very much like a pacemaker for your heart, except this device regulates the electric impulses that stimulate your brain cells.

These electrical impulses travel through the extension, which is a wire placed under your skin  to connect the neurostimulator and the electrode. The electrode, or lead, is implanted directly into your brain, where it sends electric impulses to targeted areas. Patients are usually awake during at least part of the surgery, to help doctors identify the effects of the treatment. In addition to the general idea of having brain surgery, Dr. Rosenow says that patients often feel most apprehensive about being awake.

How DBS works
Your brain sends signals to the rest of your body to for everything from physical movement to emotional sensations. These signals come in the form of electrical signals, which must travel from one neuron to the next. Some of these signals cause adverse symptoms such as tremors and mood or muscle disorders. When the electrode sends out an electrical impulse, it blocks these abnormal brain signals. The neurostimulator controls the amount of electrical stimulation, which can be adjusted externally. A patient typically does not require more surgery until the battery needs to be replaced.

Possible complications of DBS
Surgery always entails risks, and DBS requires both chest and brain surgeries. Complications of the surgical procedure include hemmorhage, stroke, infection, heart problems, incision scarring and nausea. Patients may also have trouble speaking or breathing. The surgery might affect your brain functions, causing side effects such as seizure, unwanted mood changes and insomnia.

Preparing for the surgery
People who are about to undergo DBS can help prepare for the procedure by collecting as much information as possible. Dr. Rosenow suggests that patients ask about the entire team involved in the procedure, as well as post-op device programming. They should also ask about the team’s level of experience and whether or not they will use microelectrode recording, which allows the doctors to track the brain’s electrical patterns. The doctor should provide you with information on the rate of complications at the center.