Deep Brain Stimulation

Deep brain stimulation involves the implantation of electrodes in a specific area of ​​the brain (depending on the patient’s symptoms). The electrodes can be placed both in the right and in the left hemisphere. They are implanted through small holes in the skull. At the same time, a small neurostimulator is placed in the chest area. It is connected to the electrodes by thin wires that run under the skin. When turned on, the neurostimulator sends out electrical impulses that block erroneous nerve signals in the brain that cause tremors, stiffness, increased muscle tone, and other symptoms.

The DBS system consists of three parts implanted inside the body:

• A neurostimulator is a programmable, battery-operated device that generates electrical impulses. It is placed under the skin of the chest just below the collarbone or in the abdomen.
•  Electrodes are implanted in the brain and transmit electrical impulses.
•  Microcable – a thin wire connecting the neurostimulator to the electrodes, placed under the skin (behind the ear, down the neck to the chest).

The patient can turn the DBS system on and off using the handheld controller. The neurostimulator is set up by the doctor using a wireless device (programmer). Settings can be changed as the patient’s condition changes over time.

Unlike other treatments such as pallidotomy (placement of a probe in the globus pallidus) and thalamotomy (stereotactic destruction of certain areas of the thalamus), the DBS procedure does not damage brain tissue. Thus, if more effective treatments are developed in the future, the neurostimulator can be removed without harm to the patient.

What is deep brain stimulation used for?

A doctor may recommend a DBS procedure if the patient has one or more of the following conditions:

• progressive movement disorder not responding to drug treatment;
• dyskinesias (involuntary movements) during the “on” period (the onset of the drugs);
• dyskinesia during the “off” period (completion of the action of drugs).

Deep brain stimulation is not suitable for patients with severe untreated depression, severe dementia, or symptoms that are not typical of Parkinson’s disease.

What symptoms are treated with DBS?

Deep brain stimulation can reduce symptoms caused by conditions such as:

• Parkinson’s disease: tremor, rigidity (stiffness) and slowness of movement. These symptoms are caused by the death of nerve cells that produce dopamine and are responsible for transmitting nerve impulses that control body movements.
• Essential tremor: involuntary rhythmic trembling of the hands and arms, occurring both at rest and with purposeful movements. In some cases, it can spread to the head (movements like “no-no”, “yes-yes”.
• Dystonia: involuntary movements and prolonged muscle contraction leading to twisting or wriggling of the body, tremors, abnormal posture. It can affect the whole body or only certain areas. Seizures can be suppressed by “sensory techniques” such as touching the face, eyebrows, or hands.

The effectiveness of DBS in the treatment of a number of other diseases and conditions, such as Alzheimer’s disease, Tourette’s syndrome, anorexia nervosa, restless legs syndrome, etc., is currently being studied. But so far, the therapy is experimental.