What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a medical procedure in which electrodes capable of generating electrical pulses are surgically implanted in specific regions of the brain to alleviate the symptoms of certain neurological disorders. Patients typically receive this treatment to improve tremors and other movement-related symptoms typical of Parkinson’s disease, Alzheimer’s disease, Obsessive Compulsive Disorder and Tourette’s syndrome but DBS is also being used to assuage mood-related symptoms seen in major depression. Additionally, DBS may also have some use in relieving chronic pain. The DBS apparatus contains three distinct pieces: the actual implanted electrodes, the pulse generator, and the insulated wire that connects the two. The pulse generator is typically implanted underneath the skin in the area near the clavicle of the patient and is the origin of the electrical pulses. These pulses travel through the wire and are released at the brain implantation site of the electrodes. Although the pulse generator is made to constantly send out pulses, the patient is able to turn them on and off at will via a special remote control.

BEFORE Deep Brain Stimulation PROCEDURE

Due to the invasive and potentially risky nature of the procedure, patients considering this treatment are advised to thoroughly and carefully consult with their doctor(s) to assess the necessity of the treatment as well as to discuss any potential alternatives.If it is decided that DBS is an appropriate treatment, brain imaging procedures, such as MRI, must be done to determine the correct placement of electrodes.

How it is performed

After the correct area of implantation is assessed, a surgical team fits the patient with a special frame to keep the patient’s head still during the procedure. With the help of local anesthetic applied to the scalp, the electrodes are implanted into the correct brain regions; the brain has no pain receptors so it is unnecessary to apply anesthesia to the actual brain tissue. The wire leading from these electrodes is then run underneath the skin and connected to the pulse generator which is located in a second surgical site underneath the skin near the collarbone. Local anesthetic is used for this as well.

Note that the patient remains awake during the procedure so that doctors can determine the position of the electrodes via patient responses.

Recovery

Recovery from DBS apparatus implantation is fairly simple and mostly consists of properly caring for incision wounds and managing surgery-related pain.  The pulse generator is not turned on until around 3-4 weeks after recovery.  Frequent mandatory follow-up visits to your doctor are required to evaluate patient recovery rate and to customize and program the pulse-generator to the patient’s specific needs.  Oftentimes, depending on the patient’s specific diagnosis, medication is still necessary to supplement the actions of the DBS.

Potential Risks

DBS has the typical risks of invasive surgeries such as infection, and excessive bleeding in surgical sites, irritation and inflammation.  Additionally, the actual stimulation may result in some unpleasant symptoms such as: confusion, headache, nausea, seizures, speech problems, balance issues, lightheadedness, and mood swings.  There is also a possibility of hardware complications with the DBS apparatus.  These risks are usually addressed and/or avoided by the necessary follow-up visits to the patient’s doctor after the procedure.

Cost for Deep Brain Stimulation

US from $40,000
UK from $35,000
India from $25,000

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