Deep Brain Stimulation

 

  Animated Deep Brain Stimulation Video

 

Chronic deep brain stimulation is a rapidly emerging therapy for advanced Parkinson disease . Deep brain stimulation surgery technique involves implanting electrodes inside the deep nuclei of brain called as subthalamus under local anesthesia. These electrodes are then connected to IPG (Pacemaker) implanted underneath the skin below the clavicle through the connecting leads under general anesthesia. To perform any kind of activity, the patient has to switch on the device with the help of a patient programmer. This stimulates the deep brain nuclei, which results in improvement of all the symptoms of Parkinson disease.

 

With the progress of disease the parameters of stimulation are changed over a period of time so that patients can remain symptom free for long period. The patient himself can change the stimulation parameters with the help of patient programmer. Normally the life of the pacemaker is five years and after that a new pacemaker replaces it. The electrodes remain in position for life long.Rechargeble Pace makers are now available that can be recharged at home.The life of these pace makers are 15-20 years.The stimulation of subthalamic nucleus through this device leads to improvement in all the symptoms of advanced Parkinson disease.

 

 

Deep Brain Stimulation Surgery Advantage :

 

  • In this surgery we do not injure the brain so it is relatively risk free.
  • Completely reversible and programmable
  • Parkinson medications are reduced which results in improvement of drug related side effects.
  • There is improvement of quality of life in both off and on stage of the disease.

 

 

Deep Brain Stimulation Surgery Technique

 

 

  • MRI Brain is done one day before surgery to see the deep nuclei (subthalamus) of brain.
  • Patient is kept off medication for 12 hrs.
  • This surgery is done under local anesthesia and sedation.
  • On the day of surgery Stereotactic frame (Leksell, ZD Frame) is fixed under local anesthesia, and then patient is taken to Radiology Department for CT Scanning.
  • The subthalmic target is calculated by fusing CT Scan and MRI images on work station.
  • In the operation theatre two small holes in th skull are made, Micro electrode recording is done using 5 channel MER. After analyzing the recording of MER, the track which has longest and strongest signal of sub thalamus chosen for the stimulation.After stimulation in operation theatre tremor stiffness improves.
  • DBS lead is placed in that track using C-arm.
  • DBS lead is connected to IPG (Kinetra, Libra XP "Non Reahcrgeable" and Braio "Rechargeable") under general anesthesia. This procedure is done on the same day or after one day.
  • After the Deep Brain Stimulation electrodes implantation, the next important step of this surgery is programming. Initial programming is done in two weeks time and later-on further programming is done as out patient basis in subsequent visits.Patient can himself programme using hand held patient's programmer under guidance of a neurologist or programming assitant.

 

A surgically implanted dual-channel neurostimulator, similar to a cardiac pacemaker, delivers electrical stimulation to precisely targeted areas on each side of the brain. Bilateral stimulation of these areas controls the signals that cause the disabling bilateral motor symptoms of Parkinson's disease. Deep Brain Stimulation (DBS) Therapy for Parkinson's Control is a surgical treatment proven to reduce some of the symptoms associated with Parkinson's disease (PD).

 

How it works

 

DBS uses a surgically implanted medical device, similar to a cardiac pacemaker, to deliver electrical stimulation to precisely targeted areas within the brain.
Stimulation of these areas blocks the signals that cause the disabling motor symptoms of Parkinson's disease. The electrical stimulation can be noninvasively adjusted to maximize treatment benefits. As a result, many individuals may achieve greater control over their body movements.

 

DBS System consists of three implanted components :

 

  • Lead – A lead consists of four thin coiled insulated wires with four electrodes at the lead tip. The lead is implanted in the brain.
  • Extension – An extension connects to the lead and is threaded under the skin from the head, down the neck and into the upper chest.
  • Neurostimulator – The neurostimulator connects to the extension. This small, sealed device, similar to a cardiac pacemaker, contains a battery and electronics. The neurostimulator is usually implanted beneath the skin in the chest below the collarbone (depending on the patient, a surgeon may implant the neurostimulator in the abdomen).
    Sometimes called a "brain pacemaker," it produces the electrical pulses needed for stimulation.
    These electrical pulses are delivered through the extension and lead to the targeted areas in the brain. The pulses can be adjusted wirelessly to check or change the neurostimulator settings.

 

 

Case Study