Deep brain stimulation (DBS) isa surgical technique in which an electrode (an uninsulated wire) isit places in the subcortical structures (below the surface) of the brain.This electrode connects to a stimulator (a battery), usually placednear the clavicle.
Technique
Deep brain stimulation requires precise location of an affected areaspecificity of the brain using stereotactic imaging techniques(three-dimensional) with radiography, computed tomography,CT) or magnetic resonance imaging (MRI). After opening asmall hole in the skull with a drill, special equipment allows placementimage-guided accurate electrode in the affected part of the brain. Duringsurgery, tests can be done to ensure the electrode will stimulate onlyneurons (nerve cells) that reduce symptoms. Every neurological diseasehas specific affected neurons. For example, in Parkinson’s disease, thesethey are found in the subthalamic nucleus or the pale globe (brain regions); athereditary tremor or epilepsy, the neurons of the thalamus (another region of the brain). Dicethat the most effective intensity and frequency of electrical stimulation vary betweendiseases and patients, after electrode placement tests are performedto choose the appropriate stimulation setting. Although it is not clear howDBS works, the most plausible explanation is that it reconnects brain circuits andleads to a better balance between the brain’s pathways of inhibition and excitation.
Indications
The use of DBS has been limited to severe forms of the disease that have not respondedto regular medical treatment. India approved the use of DBS in the diseaseParkinson’s disease, hereditary tremor (uncontrollable hand tremor) and dystonia(uncontrollable body movements). Its use is being studied to
- the depression;
- epilepsy;
- obsessive disordercompulsive (obsessive compulsive disorder, OCD);
- disorders offeeding;
- cluster headaches (atype of headache extremelyintense);
- chronic pain;
- Tourette’s syndrome(uncontrollable tics in theface and limbs);
- post-traumatic coma
Risks
Since DBS is an invasive procedure, complications can occurserious; among others, bleeding and infection, pathological scarring and accidentcerebrovascular Some other complications can be headaches, problemsneuropsychiatric (mood swings, apathy, hallucinations), and rupture of thecable, battery malfunction or electrode displacement. Because theBattery has a limited lifespan, it must be replaced regularly by surgery.
Limitations
DBS is expensive and requires long-term commitment from the patient, family, anddoctor. It may have unknown long-term effects. Because DBS does not cureno disease, in general only patients are considered for this treatmentwho have major disabilities and do not respond to medical treatment.