What is deep brain stimulation (DBS)?
Deep brain stimulation (DBS) is a surgical procedure that involves implanting electrodes in specific areas of the brain. These electrodes are connected to a neurostimulator, similar to a pacemaker, which is implanted under the skin. The neurostimulator sends electrical impulses to the electrodes in the brain, modulating neural activity and alleviating the symptoms of certain neurological and psychiatric disorders.
What is this treatment for?
The main uses of deep brain stimulation (DBS) are:
- Parkinson’s disease: To reduce tremors, rigidity, slowness of movement, and other motor symptoms.
- Essential tremor: To reduce uncontrollable tremors.
- Dystonia: To reduce involuntary muscle contractions and abnormal movements.
- Obsessive-compulsive disorder (OCD): To reduce obsessive thoughts and compulsive behaviors.
- Treatment-resistant depression: To alleviate symptoms of depression that do not respond to other treatments.
Benefits of high technology in DBS
Deep brain stimulation (DBS) offers a series of key benefits thanks to the technology it uses:
- Improved quality of life: DBS can significantly improve patients’ quality of life by reducing the symptoms of their disorders.
- Precise planning: High-resolution magnetic resonance imaging (MRI) allows for precise identification of the brain areas to be stimulated.
- Advanced surgical guidance: Intraoperative MRI or CT, along with neuronavigation systems, allow for guiding the placement of electrodes with millimeter precision.
- Personalized stimulation: The neurostimulator programming is done individually for each patient, adjusting the stimulation parameters to maximize benefits and minimize side effects.
What is the procedure like?
Deep brain stimulation (DBS) is a complex procedure performed in several stages:
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Preparation:
It is important to inform your doctor about any allergies you have, especially to metals. You should also report all medications you are taking, including over-the-counter drugs and supplements. You may need to stop some medications before surgery, such as blood thinners and medication for tremor or Parkinson’s disease.
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During the treatment:
The procedure is performed in two main stages.
- First stage
A stereotactic frame will be placed on your head to guide the placement of the electrodes. An MRI and CT scan will be performed to obtain detailed images of your brain, and then you will be taken to the operating room, where peripheral lines will be placed in case you need medication during surgery, and you will also be catheterized. You will be given local anesthesia and sedation. Small incisions will be made on the scalp and small holes will be drilled in the skull. It may be necessary to cut some of your hair. During the procedure, you will need to remain awake and attentive to any simple instructions from the doctor, as brain activity will be recorded through the implanted electrodes to allow for precise placement.
- On the same day, after the electrodes have been placed inside the brain, you will be given general anesthesia to place the neurostimulator (pacemaker). An incision will be made in the chest, below the collarbone. A pocket will be created under the skin to house the neurostimulator. Finally, the brain electrodes will be connected to the neurostimulator. Both the neurostimulator and the wires connecting it to the electrodes will be under the skin.
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After the treatment:
After the surgery, the incisions on the scalp and chest will be closed. You may need to stay in the hospital for a few days to monitor your recovery. You will be given instructions on how to care for the incisions and what signs of infection to watch for. An appointment will also be scheduled to activate and program the neurostimulator.
Recommendations for the treatment
Remember that it is important to follow these recommendations to ensure the quality of the study and your comfort:
- Incision care: Follow your doctor’s recommendations on how to care for the incisions after surgery.
- Report allergies: It is crucial to inform the medical staff if you have a known allergy to any metal or any other material used in the procedure.
- Report medications: It is important to inform your doctor about all the medications you are taking, including over-the-counter drugs and supplements.
- Stop certain medications: You may need to stop certain medications before surgery, such as blood thinners. Follow your doctor’s instructions.
- Preoperative instructions: Carefully follow all instructions provided by your doctor or hospital staff.
Are there any risks?
Deep brain stimulation (DBS) is generally safe, but like any surgical procedure, it has some minimal risks to consider:
- Infection: Like any prosthesis placed in an organism, there is a risk of infection at the incision site or around the electrodes or generator. The risk is very low and is minimized with antibiotic treatment.
- Hemorrhage or stroke: There is a risk of bleeding in the brain during the placement of the electrodes, which is around 1%. In older patients, those with hypertension, or in relation to certain drugs, it may be more frequent.
- Hardware-related complications: Problems with the hardware can occur, such as electrode displacement or wire breakage, but this is uncommon if proper precautions are taken.
- Side effects: Side effects related to stimulation may occur, such as speech problems, balance problems, mood changes, or cognitive problems. These issues can usually be resolved by appropriately modifying the programming.
To ensure your treatment goes smoothly, we ask that you arrive before the scheduled time. This will allow us to complete the necessary administrative and clinical preparation.
Beforehand, we will give you the Informed Consent, a document with important information that you must read and sign.
These treatments are very safe, but as with any medical procedure, there is a minimal possibility of an incident.
