What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a neuro-surgical procedure introduced in 1987, to treat a variety of neurological disabling symptoms. DBS involves implantation of a battery operated medical device called a neuro-stimulator, which is similar to a pacemaker and approximately the size of a stopwatch. This neuro-stimulator sends electrical stimulation to targeted areas in the brain that control movement disorders.
DBS is most commonly used to treat the symptoms of Parkinson’s disease (PD) such as tremor, rigidity, stiffness, slow movement, and walking difficulty. DBS is not only used to treat PD, but also has provided therapeutic benefits in various other disorders like essential tremors, dystonia, chronic pain, major depression, and obsessive–compulsive disorder.
How does Deep Brain Stimulation Surgery work?
In people with PD, electrical feedback loops of the brain function are askew. The brain experiences imbalance because some parts show excessive activity while other parts are under-active.
Normal muscle movements of arms and legs are replaced by tremors, rigidity, and slowness in Parkinson’s Disease. By providing electrical stimulation to deep brain structures using neuro-stimulators, it is possible to jam abnormal signaling that occurs between the deep brain structures. This does not cure PD, but returns the electrical activity of the brain to a normal state, thereby reducing the main motor symptoms of PD.
The DBS system is made up of 3 parts- the electrode/lead that is placed within the affected brain region, the extension, which is a wire placed under the skin to the neurostimulator and the battery/neuro-stimulator which is placed beneath the skin of the collarbone or abdomen.
It is important to note that DBS does not destroy healthy brain tissues, but only blocks electrical signals from targeted brain areas.
Who should undergo DBS Therapy?
- Patients suffering from PD for over 5 years and experiencing tremors, muscle disorders, epilepsy, or tremors due to multiple sclerosis and other movement-related disorders that cannot be treated with medication.
- Patients experiencing intolerable side effects of Parkinson’s medications i.e. on/off fluctuation frequently
- Everyone is not eligible for DBS- the person’s mental state and general health conditions are taken into consideration too. It is important that a movement disorder expert or an experienced neurologist be consulted.
- Individuals with dystonia (muscle tone disorders) do not respond to DBS in the same manner as those with other movement disorders. It is seen that people with PD rapidly respond to DBS treatment. In patients with dystonia, improvement may be delayed for days, weeks, or even months. DBS does not necessarily eliminate the possibility of subsequent drug or botulium toxin treatments.
When should DBS surgery be considered?
Some doctors recommend surgery for individuals with mild PD, which is thought to delay the progression of the disease. However, there is not enough evidence that proves the delay of disease progression or protection of brain cells. On the other hand, surgery may prove beneficial in improving the quality of life of people with PD who have entered the phase of dyskinesias, i.e., impaired voluntary movement.
At some Indian centers, potential DBS therapy candidates have to undergo a simple test aimed to predict the results of surgery. This test is called the ‘levodopa challenge’. The person with PD is given a large dose of dopamine medicated drug apomorphine and the improvement that follows the dose is correlated with the potential benefit of DBS.
Each person with PD is unique and their goals for surgery are different; some want to reduce tremors while some want to reduce dyskinesia. It is very important that individuals opting for surgery have a clear idea as to what can and what can’t be fulfilled using DBS.
DBS involves implanting electrodes inside the deep nuclei of the brain known as the subthalamus; this is performed under anesthesia. These electrodes are then connected to the implantable pulse generator, which is placed underneath the skin through connecting wires; this too is performed under general anesthesia. To perform any kind of activity, individuals have to switch on the device with the help of a patient programmer. This will stimulate the brain nuclei and improve the symptoms of PD.
DBS Procedure- Step by Step
- The head is shaved, and the head frame is attached to the skull.
- Magnetic resonance imaging is performed for brain mapping.
- Two holes are drilled into the scalp; the person does not feel any pain because he is given anesthesia.
- Electro-physiological brain mapping is done using a microelectrode.
- The deep brain stimulator is then inserted into the brain.
- Implantable pulse generator is placed in the chest wall and connected through a wire in chest, tunneled under the skin of neck, and connected to the deep brain electrode at the scalp.
The recovery period is fairly small, and most people are discharged 24 hours after surgery and can resume their normal activities.
- Risk to brain injury is negligible.
- DBS is easily reversible and programmable.
- Good improvement in the quality of life is generally observed after this surgery; this includes people at both the ‘on’ and ‘off’ stages of the disease.
- Stimulator is adjusted to the need of the individual.
- Significant relief is experienced by individuals in PD symptoms
- Medication dosage can be reduced significantly, thereby reducing their side effects
DBS surgery in India
Indian neurologists and neurosurgeons are considered to be among the best neurosurgeons in the world. Many Indian doctors and healthcare professionals receive international training, have worked at the best hospitals in the world, and are competent to handle such delicate and complicated cases.
Today, India is at the forefront of medical tourism with treatment costs being much lesser than other countries. People from different countries travel to India to seek medical treatment because these facilities are either expensive or unavailable in their own country. Indian hospitals are well equipped with world class amenities and infrastructure.
Quality accommodation options with all the required amenities to help you during and after the procedure are readily available in India. Travelling to India for your medical procedures may very well turn out into a vacation that you can cherish forever.
For more information about DBS surgery in India, write to us at firstname.lastname@example.org or call us at +91-932-003-6777 or +1-877-27–2448 (US Toll Free) or talk to us at Skype @ Indicure