What Is The Role Of The Neurologist In DBS Surgery?

Deep brain stimulation (DBS) is a medical procedure which involves a mild electrical current delivered to a specific part of your brain. The electricity in that current stimulates the brain cells in that area, which can help several conditions. The current reaches your brain through one or more wires attached to a small device implanted underneath your skin near your collarbone. It is generally used for managing conditions like Parkinson’s disease and epilepsy, but researchers are investigating if it can help many other conditions too.

The primary responsibility of the neurologist in DBS treatment is patient selection. Neurologists should be knowledgeable about the appropriate uses and restrictions for DBS and promptly introduce it to patients who will likely benefit from it. Neurologists administering this treatment should also be fully aware of the potential side effects and how to prevent them.

What Is Deep Brain Stimulation (DBS)?

Deep brain stimulation (DBS) is a medical procedure that involves applying a mild electrical current delivered to a specific part of your brain. Numerous disorders like epilepsy, Parkinson’s disease, and dystonia can benefit from the stimulation of brain cells in that region caused by the electricity in that current. 

Why Is Deep Brain Stimulation Done?

Deep brain stimulation is a comprehensive treatment for people with movement conditions like essential tremor, Parkinson's disease and dystonia. It is also used for psychiatric conditions such as obsessive-compulsive disorder. Furthermore,  deep brain stimulation has been approved by the Food and Drug Administration as a treatment to reduce seizures in difficult-to-treat epilepsy. Deep brain stimulation is performed in people whose symptoms are unable to be controlled with medicines.

Which Conditions Can Be Managed By Deep Brain Stimulation (DBS)?

The following are the most common conditions which can be managed by deep brain stimulation:

• Dystonia
• Parkinson’s disease
• Epilepsy
• Essential tremor
• Tourette syndrome
• Obsessive-compulsive disorder (OCD)

The following are the conditions that might benefit from deep brain stimulation:

• Chorea
• Chronic pain
• Dementia (Alzheimer’s disease)
• Cluster headache
• Depression
• Addiction
• Obesity
• Schizophrenia
• Eating disorders
• Anxiety 

How Deep Brain Stimulation Surgery Is Done?

The deep brain stimulation system consists of 4 parts such as insulator wires called electrodes or leads (these electrodes/leads are attached to the skull), anchors (they help to fix the electrode into the skull), neurostimulator (helps to put out the electric current), and an extension (it helps to connect lead to neurostimulator). Deep brain stimulation surgery is done to place each part of these neurostimulator systems. In adults, it can be carried out in 2 stages in which stage 1 is done under local anesthesia and stage 2 is done under general anesthesia. These 2 stages are 2 separate surgeries.

The following are the steps in the stage-1 DBS surgery procedure:

• A small portion of hair on your head is shaved
• Your neurologist will place your head in a special frame using small screws to keep it steady during the procedure. Aesthetics are applied where the screw comes in contact with the scalp.
• Aesthetic is applied on your scalp to numb the area. The surgeon will make small incisions and then drill a small opening in the skull to place the lead.
• If both sides of the brain have to be treated, the surgeon will make an opening on each side and two leads will be inserted.
• Through these leads, electrical impulses are sent to ensure it is connected to the area of the brain responsible for your symptoms.
• Your doctor Will ask you questions, read cards, describe images, and move your arms or legs to ensure electrodes are placed in the correct position and the desired effect is achieved.

The following are the steps in the stage-2 DBS Surgery procedure:

• The surgeon makes small incisions, often done just below the collarbone (sometimes placed under the skin in the lower chest or belly area) and inserts the neurotransmitter.
• The extension wire is attached to the neurostimulator by being inserted under the skin of the head, neck, and shoulder.
• The incision is closed.  The skin can appear as a slight bump as the device and wires are implanted under the skin.  Once connected, electric pulses travel from the neurostimulator, along the extension wire, to the lead, and into the brain. 

What Are The Advantages Of DBS Surgery?

• Depending on the symptoms experienced by the patient, DBS surgery can be done on both sides of the brain
• The effects are reversible and can be tailored individually for each patient’s clinical status
• Stimulation settings can be modified which are beneficial to minimize the side effects and to improve the effectiveness over a period of time
• The device can provide persistent symptom control 24 hours a day
• Patients who have undergone DBS can pursue other treatments, such as stem cell or gene therapy when they become available
   

What Are The Complications Of DBS Surgery?

The following are the possible complications of DBS surgery:

• Infection /sepsis
• Bleeding
• Swelling around the brain
• Coma
• Stroke

The following are the complications occurring  because of the leads and pulse generator:

• Incorrect placement or displacement of the lead from the implanted position
• Failure to function of the lead or pulse generator
• Soreness or pain around the pulse generator
• Lead wires getting loose from the pulse generator

Apart from the above, the following are the side effects of DBS:

• Balance problems
• Lack of concentration or inability to focus
• Vision disturbances
• Memory problems
• Confusions
• Seizure
• Depression
• Tingling or numbness in some parts of the body
• Sudden weakness
• Lack of muscle control

Exploring The Role Of The Neurologist in DBS Surgery?

Deep brain stimulation (DBS) has been recognised as an effective treatment for medically refractory Parkinson's disease, epilepsy, and dystonia. The effectiveness of DBS depends on appropriate patient selection, precise and safe surgery, and appropriate postoperative medication and stimulation adjustments. The main role of the neurologist in DBS treatment is patient selection. Neurologists should be aware of the appropriate uses and precautions when introducing DBS to patients who will benefit significantly from it. Neurologists administering this treatment should also be fully aware of the potential side effects and how to prevent or avoid them.

Conclusion

Deep brain stimulation (DBS) is a treatment option which can help with a wide range of conditions that affect your brain function and mental health.  Patients with epilepsy, Parkinson's disease, and dystonia benefit from it, and studies are being conducted to see if it may be used to treat a wide range of additional disorders. Before surgery, learn from a medical practitioner what kind of improvement you should anticipate.

To learn more about the possibilities of a painless future, and the greatest results, choose IBS Hospital, the home of innovative brain care. Schedule your consultation today! 

FAQs

Q: What is Deep brain stimulation?
A: Deep brain stimulation (DBS) is a medical procedure that involves applying a mild electrical current delivered to a specific part of your brain. Numerous disorders like epilepsy, Parkinson’s disease, and dystonia can benefit from the stimulation of brain cells in that region caused by the electricity in that current. 

Q: How much does Deep brain stimulation surgery cost?
A: Depending on where you reside, the type of surgery done, the doctor's fee, your health status, the investigational tests performed, and the insurance coverage you have, deep brain stimulation can cost different amounts. Connect with IBS hospital with the best availability of neurologists in Delhi to know more.

By -Dr Aaksha Shukla | May 09, 2024 | 9 Min Read