Deep Brain Stimulation (DBS)

Once the lead is effectively placed, programming must be optimized to maximize the clinical outcome. There is no single algorithm for DBS programming or reprogramming in movement...

Overview

Deep brain stimulation (DBS) is a neurosurgical procedure involving the implantation of a medical device called as neurostimulator or the ‘brain pacemaker’, which sends electrical impulses, through implanted electrodes, to specific targets in the brain (brain nuclei).

The DBS system consists of very thin DBS Lead which contains four- eight electrode contacts which are implanted into the target area in the brain. The lead extends through a small opening in the skull and is connected to the extension that is then connected to an impulse generator or pacemaker which is implanted under the skin over the chest. DBS exerts its therapeutic effect by delivering electrical impulses to the target region.

Deep Brain Stimulation is an alternative to ablative surgeries conventionally offered for Parkinson’s disease and other related movement disorders. The common targets for DBS surgery within the brain, for movement disorder include, subthalamic nucleus (STN) for Parkinson’s disease, Ventrointermedius nucleus of thalamus for tremors, and pallidum for dystonia. Though each of this target sites can be used for different movement disorder, we believe that these are best for the respective disease as indicated.

During the last decade deep brain stimulation (DBS) has become a routine method for the treatment of advanced Parkinson’s disease (PD), leading to striking improvements in motor functions and quality of life of PD patients. It is associated with minimal morbidity. More than 1,50,000 patients must have undergone DBS surgery for Parkinson’s disease around the world.

The therapy of Deep Brain Stimulation requires additional expertise over conventional stereotactic techniques that are required for functional neurosurgical procedures for movement disorder. It requires careful understanding of the principles of DBS, understanding of the disease being treated and combining the medical therapy along with stimulation to achieve smooth control of the disease. Jaslok Hospital & Research Centre has been able to develop a multi-disciplinary team to undertake this surgery.

The team comprises of Neurosurgeon, Neurologist, Clinical research fellow, Parkinson’s disease nurse, neuro-psychiatrist and physiotherapist. Expertise of speech therapist, occupational therapist and other specialists is obtained when required.

The success of the therapy largely depends on the selection of the appropriate candidate patients and on the precise implantation of the stimulation electrode, which necessitates careful imaging-based pre-targeting and extensive electrophysiological exploration of the target area.