How Deep Brain Stimulation Works For Parkinson’s

Risks And Side Effects Of Deep Brain Stimulation

Like any surgery, deep brain stimulation can have side effects, and it carries potential risks. Its also important to consider the complications and side effects of medications you take since their dosages can often be reduced following surgery.

While DBS may cause side effects, it may also reduce side effects from medications.

Altering Erratic Neuronal Activity

The abnormal electrical discharge activity that causes the disease is altered by deep brain stimulation. The normal function of neurons is due to constant and regular pattern of activity & this pattern is disrupted by irregular or chaotic firing of neurons.

These abnormally discharging neurons are modified by Deep Brain Stimulation into a pattern of more regular firing which is less deleterious.

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What Are The Risks And Complications Of Deep Brain Stimulation

As with any surgical procedure, there are risks and complications. Complications of DBS fall into three categories: surgery complications, hardware complications, and stimulation-related complications.

• Surgical complications include brain hemorrhage, brain infection, wrong location of the DBS leads, and less than the best location of the leads.
• Hardware complications include movement of the leads, lead failure, failure of any part of the DBS system, pain over the pulse generator device, battery failure, infection around the device and the device breaking through the skin as the thickness of skin and fat layer change as one ages.
• Stimulation-related complications occur in all patients during the device programming stage. Common side effects are unintended movements , freezing , worsening of balance and gait, speech disturbance, involuntary muscle contractions, numbness and tingling , and double vision . These side effects are reversible when the device is adjusted.

Deep Brain Stimulation Results

DBS is perhaps most famously used in the treatment of Parkinson’s disease. Prominent actor Michael J. Fox helped to bring Parkinson’s to the eyes of the public when he revealed his diagnosis with the disease. Essential tremor and dystonia are two other movement disorders that are also commonly treated with DBS. Essential tremor is characterized by tremors during muscle movements and is actually the most common movement disorder in the United States. Usually medication alone is sufficient to treat essential tremor, but sometimes severe cases require treatment with DBS.

Dystonia is a disorder resulting in unwanted muscle contractions. Notably, the DBS implantation surgery is performed differently in the case of dystonia. Because dystonia patients are unable to suppress the head and neck movements that are part of their symptoms, the patients must be placed under general anesthesia during the electrode implantation surgery. As we’ll later learn, this situation can make proper electrode implantation more challenging for the doctor.

Parkinson’s disease, essential tremor and dystonia are all movement disorders that share symptoms treatable by DBS stimulation to the basal ganglia. DBS can also be used on brain regions outside the basal ganglia to treat other conditions caused by abnormal brain function. The most common use of DBS is actually for the treatment of chronic pain.

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Living With A Dbs Device

Batteries most often last three to five years, but this can vary. Rechargeable batteries may last up to 15 years.

There are several precautions related to electrical/magnetic devices that are important, but usually easy to accommodate. Items such as cell phones, computers, and home appliances do not generally interfere with the stimulator. Keep your stimulator identification card handy when you are out and about, in your wallet or purse.

Theft Detectors

Be aware that some devices may cause your transmitter to turn on or off. This includes security monitors that might be found at the library and retail shops.

If this occurs accidentally, it is not usually serious, but may be uncomfortable or result in your symptoms worsening if the stimulator is turned off. When you visit stores with these devices, you can ask to bypass the device by presenting your stimulator identification card.

Home Electronics

Keep the magnet used to activate and deactivate the stimulator at least 12 inches away from televisions, computer disks, and credit cards, as the magnet could potentially damage these items.

Air Travel/Metal Detectors

Talk to TSA personnel when traveling by plane, as the metal in the stimulator may set off the detector. If you are asked to go through additional screening with a detector wand, its important to talk to the person screening you about your stimulator.

Medical Diagnosis and Treatment

Occupational Electromagnetic Concerns

What It Feels Like: Deep Brain Stimulation For Parkinson’s Disease

Emma Jones,

Manzil Bacchus was diagnosed with Parkinsons disease in 2008. Initially, he was told that there was nothing he could do to stop the progression of the progressive nervous system disorder that affects movement. Manzil and his wife, Sadia, continued to manage the increasingly worrisome symptoms which included tremors and the growing amount of medication that he had to take each day.

After Manzil was diagnosed with colitis, a chronic digestive disease that has been linked to Parkinsons, the family began investigating a new surgical option. In deep brain stimulation , electrodes are inserted in regions of the brain that have been affected by the Parkinsons, with an impulse generator battery also inserted in another area of the body. When turned on, the electrodes send gentle electrical pulses to help improve symptoms like tremors and motor control.

Manzil and Sadia sat down with Healthing to talk about Manzils experience having brain surgery during the COVID-19 pandemic and the difference that deep brain stimulation has made to his quality of life.

When was Manzil diagnosed with Parkinsons?Manzil: Back in 2007, my hands started shaking. I was volunteering at a mosque, helping people to take a pilgrimage in Saudi Arabia, helping with their application for visas and stuff like that. One of the girls noticed my hand shaking and asked why. I thought I was just tired. After that, I also noticed that my left foot was dragging when I walked.

Sadia: Sadia: Sadia:

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How Does The Neurosurgeon Know Where To Place The Electrodes In My Brain

Positioning the electrodes in the brain is the most critical step. The electrodes have to be placed in an exact location in the brain to improve symptoms. Computed tomography or magnetic resonance imaging scans are taken before and/or during the procedure to pinpoint the exact areas to target and guide the lead and electrode placement. Many times an electrode may be used to record brain cell activity at the target site to improve lead placement.

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How Is Deep Brain Stimulation Used To Treat Parkinsons Disease

Deep brain stimulation delivers electrical impulses to a targeted area of the brain that is responsible for the movement symptoms caused by Parkinsons disease. The electrical impulses disrupt the abnormal activity that occurs in the brains circuitry, which is causing the symptoms.

There are three areas in the brain that can be targets for deep brain stimulation in patients with Parkinsons disease. They are the subthalamic nucleus, the globus pallidus internus, and the ventral intermediate nucleus of the thalamus. Each of these areas plays a role in the brains circuitry that is responsible for the control of movement.

The specific area in the brain to target in an individual with Parkinsons disease depends on symptoms that need to be treated. For example, deep brain stimulation of subthalamic nucleus is effective for all major movement symptoms of Parkinson’s disease, such as tremor, slowness of movement , stiffness , and problems with walking and balance. Deep brain stimulation of globus pallidus is another effective target for a wide range of Parkinson’s symptoms. The thalamic target is sometimes selected for patients with tremor symptoms. The recommended target for each patient is made collaboratively with the neurologist, neurosurgeon and other caregivers involved in the decision making process.

Placement Of The Neurostimulator

This procedure takes place under general anesthesia so that the person is asleep. The surgical team inserts the neurostimulator under the outer layers of skin, usually just under the collarbone, but sometimes in the chest or abdomen. The extension wire from the lead is attached to the neurostimulator.

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What Is Deep Brain Stimulation How Does Dbs Work

DBS is the short form of Deep Brain Stimulation. DBS is one type of Parkinsons Surgery.

DBS works by passing a small current into the brain. This current is passed into only to a small part of the brain.

The doctor selects one out of two brain parts .

DBS works by changing the electrical currents in these areas. At present, we cannot mathematically calculate these changes.

But, empirically DBS improves Parkinsons symptoms.

Let us learn more about these topics:

• NeuroPlus Epilepsy & Parkinson’s Clinic Dr. Kharkar

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Why A Doctor May Choose Deep Brain Stimulation

According to the National Parkinson Foundation, the ideal Parkinsons disease candidate for DBS surgery has:

• PD symptoms that interfere with activities of daily living.

• Fluctuations in mobility due to PD medications with or without dyskinesia .

• Continued good response to PD medications, even if the medication effects may wear off sooner than they have in the past.

• A history of several different combinations of PD medications while under the supervision of a neurologist specializing in movement disorders.

These factors* may make a person a less than ideal candidate for DBS surgery:

• Difficulty with balance, walking, or freezing as the main disabling symptom.

• A primary symptom of speech difficulty.

• Continuous confusion and problems with memory and thinking.

• A psychiatric condition such as depression or anxiety that has not improved or stabilized with other treatment.

• Another condition that increases the risk for surgery complications.

*Some of these factors may be treatable. Having one or more does not disqualify a person for future DBS surgery, but the doctor may recommend more aggressive therapy focused on these issues before surgery takes place.

What Is Deep Brain Stimulation For Parkinsons Disease

DBS is electrical stimulation of the brain by using a small machine. DBS can stimulate many brain areas.

DBS is actually approved for many diseases. It is not just a Parkinsons surgery. It can be used for epilepsy and other movement disorders as well.

The basic setup is the same.

The DBS battery is inserted below the chest skin. Two small wires from the battery go up to the head. The wires go through the skull. They are inserted into the desired area of the brain.

For Parkinsons disease: This target area of the brain is usually the Subthalamic Nucleus .

In some patients, another area is chosen as the target. This other area is the Globus Pallidus interna .

How is the target chosen? Read this article

DBS can dramatically improve Parkinsons symptoms. There are many before-after videos available on the internet.

For example, here is a video posted on youtube by the Neuromedical Center in USA.

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So Should I Get Dbs Surgery For Parkinsons

How does DBS work? is a good question. Should I get DBS? is a separate question.

The success rate of DBS is quite high. If the patient is properly selected, most of them benefit from it. You can read more about DBS patient criteria here .

In addition to the correct patient, the proper target needs to be selected.

Most patients get at least 4.5 additional good hours. You can read more about DBS success rates by clicking here.

The risks of DBS surgery are low. You can read more about the risks by clicking here.

One of the main barriers to DBS surgery is cost. Thankfully, it is cheaper to DBS surgery in India. You can read more about DBS cost in India and other specifics here.

How Does Deep Brain Stimulation Work

No one completely understands how Deep Brain Stimulation works.

Doctors used to cut small parts of the brain to reduce Parkinsons symptoms. This surgery is called a tomy, meaning to cut. For example, Thalamo-tomy, Pallido-tomy.

A small electrical current is used to stop small bleeds during surgery. This is called electrical cautery.

While doing this current, they noticed something odd. When they passed a current into certain brain parts, the Parkinsons tremor disappeared!

Would it be possible to continue the stimulation indefinitely? This question led to the design of the DBS electrical system around 2000. DBS was approved for widespread use in 2002.

Reference:

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Many researchers believe DBS stimulates the target. Some believe DBS actually causes the target to stop working.

The reality is complex, and as yet, out of reach.

Each of these targets contain many millions of little cells arranged in very intricate circuits.

Probably, the DBS current stimulates some of these cells, while other cells stop working. Some circuits go into overdrive, while others shut down.

This varying effect also varies according to the current characteristics, especially frequency.

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Deep brain stimulation is basically a black box, says Guoping Feng, a neurobiologist at Duke University in Durham, N.C. Scientists know that inserting an electrical probe deep into the brain and stimulating an area known as the subthalamic nucleus can help people with Parkinsons disease overcome the disorders neurological block on movement.

But much controversy surrounds the mechanism by which the stimulation works. Some researchers think the technique stimulates neurons that initiate movement. Others say it blocks inhibitory neurons, allowing brain signals to resume. And yet another theory holds that it influences the flow of information along axons fibers that connect neurons to each other.

A study published online March 19 in Science shows that deep brain stimulation exerts its effect on axons, specifically those that feed into the subthalamic nucleus, rather than on the neurons in the structure.

When the researchers turned on the light in cells in the subthalamic nucleus nothing happened. But light stimulation of incoming axons improved the mices movements. Quieting activity of the axons made the movement disorder worse.

This is a big change in the way we look at the circuit, says Romulo Fuentes, a neurophysiologist at Duke University.

Questions or comments on this article? E-mail us at

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How Long Does The Battery In The Impulse Generator Device Last

Batteries can last 3 to 5 years in non-rechargeable devices and up to 15 years or even longer in rechargeable battery devices. However, these times may vary significantly. A simple outpatient procedure is needed to replace the battery. Rechargeable battery devices can be charged daily or every 10 to 14 days . Your doctor will discuss how often you should recharge your battery based on your therapy settings.

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