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Deep brain stimulation (DBS) is a type of therapy that uses electrical stimulation to treat neurological conditions such as Parkinson disease (PD), essential tremor, and multiple sclerosis. DBS can be effective in treating movement problems such as tremors, stiffness, difficulty in walking, and slowed movement. While it does not cure these conditions, DBS can ease symptoms and decrease the amount of medications you need to treat the symptoms, thus improving your quality of life.
Movement-related symptoms of PD and other neurological conditions are caused by faulty electrical signals in the areas of the brain that control movement. Unlike earlier surgical procedures that destroyed brain tissue to eliminate the faulty signals, DBS does not damage brain tissue. Instead, it blocks the faulty signals that cause tremors and other movement symptoms.
This is done by placing an electrode inside the brain. The electrode is connected to a very small neurostimulator (electrical generator) implanted in your chest or abdomen. Electric current is delivered from the neurostimulator through the electrode to the targeted area of brain tissue responsible for symptoms.
DBS may be an option for some people with specific neurological conditions when medications have become less effective and/or when side effects of the medications interfere with daily activities.
One of the primary uses of DBS is to treat Parkinson symptoms when Parkinson drugs become less effective, or when movement problems or side effects worsen.
DBS may also be used to treat:
Your health care provider may have other reasons to recommend DBS.
Not all people with these conditions are good candidates for DBS. Talk with a neurologist who specializes in movement disorders to determine if you are a good candidate for DBS.
As with any surgical procedure, complications can occur. Possible complications include:
Side effects that may occur after the surgery include:
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your health care provider before the procedure.
DBS requires a commitment to participate in evaluations, procedures, and consultations before and after the procedure. DBS is usually only available in large medical centers. If you do not live close to a medical center that offers DBS procedures, you may need to spend significant time traveling. The procedure and associated appointments can be expensive. It is also important for you to have realistic expectations about DBS results. Although DBS can improve symptoms, it will not cure the condition.
Before DBS, you will have assessments to determine whether this is a good option for your and tests to evaluate memory and thinking. A psychiatrist may examine you to determine if you have a condition, such as depression or anxiety that requires treatment before the DBS procedure.
Ask your health care provider about what you might need to do in the days and weeks before your procedure, such as if there are any special dietary or medication restrictions.
Implantation of a DBS lead generally requires a hospital stay of one day or longer. Procedures may vary depending on your condition and your health care provider’s practices. The lead and neurostimulator may be implanted at the same time, or the neurostimulator may be implanted in a separate procedure after the lead is implanted. Talk with your health care provider about what you will experience during your procedure.
Generally, surgery for DBS follows this process:
This may or may not be done at the same time the electrode is placed.
Programming the neurostimulator is a process that occurs over time. You will likely return several times for adjustment to the settings. Your medications may also be adjusted. The goal is control your symptoms with the most appropriate amount of electrical stimulation and medication.
Once your “best” settings have been determined, you will need to return periodically for checkups. Your health care provider will determine your follow-up schedule based on your particular situation.
You will be given a magnet to turn the neurostimulator on or off under conditions prescribed by your health care provider.
The neurostimulator is powered by a long-lasting battery that generally lasts 3 to 5 years. When the battery begins to wear out, the neurostimulator will be replaced with a new one in an outpatient procedure.
You will be watched for complications, such as seizures. In general, the hospital stay after a DBS procedure is 24 hours; however, you may stay longer if complications develop. Before you are discharged from the hospital, arrangements will be made for a follow-up visit with your health care provider. He or she will also give you instructions for home care.
Once you are home, it’s important to keep the incisions clean and dry. Your health care provider will give you specific bathing instructions. If stitches were used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.
The following precautions should always be considered. Discuss the following in detail with your health care provider:
DBS can help improve symptoms of tremors, stiffness, slowness, and dyskinesias. It can also help with medication therapy by decreasing the dose needed. Decreasing the dose of medication can ease side effects of long-term medication use. Many people continue to have improvements in their symptoms for several years after the procedure. They are able to perform basic activities, such as eating, toileting, and dressing. Memory, thinking, and mood may or may not be affected. Many neurological conditions are progressive, so later complications can develop. If these complications develop, the gains obtained from DBS may eventually be lost.
Before you agree to the test or the procedure make sure you know:
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