Neurological and psychiatric disorders can be debilitating to live with, even with the right treatment and medications, symptoms can still be hard to manage. Surgical procedures like Deep Brain Stimulation can give symptomatic relief by modulating brain activities that cause these symptoms.
Neurological disorders such as Parkinson’s disease or essential tremors can make daily activities challenging.
What is DBS?
Deep Brain Stimulation (DBS) is a treatment procedure involving the insertion of electrodes into the brain. A wire under the skin connects these electrodes to an implantable pulse generator device implanted in the chest [1]. Clinicians will then adjust the stimulation patterns according to the location (which electrode), amplitude, frequency, and pulse width [1].
DBS has been used in movement disorders such as Parkinson’s disease, essential tremors, and dystonia for over 40 years, more recently it has found its application in the treatment of psychiatric conditions [2].
The exact mechanism of how DBS works is not fully understood, scientists believe that the electrical stimulation delivered by the electrodes modulates the abnormal circuits in the brain, bringing them closer to normal physiological condition [2]. It does this by stimulating the neurons around the electrode, causing the opening or closing of voltage-gated ion channels, which consequently controls the release of neurotransmitters between neurons, hence altering communication between neurons [2].
Deep brain stimulation involves implanting electrodes in the brain, which is controlled by a pacemaker-like device in the chest.
What does DBS treat?
DBS has been used for a number of neurological and psychiatric disorders such as:
However, scientists are actively studying the application DBS in other conditions such as [3]:
Depression
Anxiety
Addiction
Schizophrenia
Anorexia nervosa
Autism
What are the benefits of DBS surgery?
DBS surgery can benefit patients who find that their symptoms affect their ability to do daily activities. Several advantages of DBS as a treatment include:
Improves movement control – In patients with movement disorders, DBS allows them to control their tremors or twitches.
Reduces dependency on medications – DBS can be an option for patients who find that medications are no longer effective in managing their symptoms. DBS can also reduce dependency on medication and reduce the dosage required to manage symptoms.
Customisable settings – The pulse generator implant can be customised to suit each patient’s need and settings. Hence, the treatment is highly personalised and customised.
What to expect for a DBS procedure
DBS is usually only indicated for patients who are resistant to other forms of treatment like medications and therapy. The doctor will only recommend DBS as a last resort if your condition is refractory to standard treatment [3]. Once your doctor clears you for DBS the surgery will go as follows:
Imaging - The doctor will perform MRI scans or CT scans on your head to map out the locations where the electrodes will be implanted.
Brain surgery - A stereotactic head frame is placed on your head to keep the head still during the procedure. The surgery can be done with general anaesthesia (patient unconscious) or local anaesthesia (patient conscious). The brain itself will not need anaesthesia because it does not have any pain receptors. The neurosurgeon will then place thin wires carrying the electrodes into the brain. This wire runs just underneath the skin and leads to the pulse generator in the chest wall.
Chest surgery - The chest surgery is performed to implant the pulse generator within the chest wall, commonly near the collarbone [1]. This surgery is performed while the patient is under general anaesthesia.
Pulse generator programming - Several weeks after the surgery, you will be required to come in to allow the neurologist to programme the pulse generator and set its parameters. The pulse generator is also connected to a remote control that you will carry.
It is also important to schedule follow-up appointments with your neurologist and report anything out of the ordinary, this includes any possible complications from the surgical procedures.
Who is a good candidate for deep brain stimulation (DBS)?
Doctors usually recommend DBS for patients whose symptoms no longer respond to medication or therapy, or who experience severe side effects from the use of medication.
Are there any risks associated with DBS?
As with other surgical procedures, DBS can carry risks involved with surgery such as [2]:
Intracerebral bleeding
Seizures
Deep vein thrombosis
Phlebitis (blood clots in your veins)
Pneumonia
UTIs
Migration and fracture of implanted device
Infections
However, these reported complications are relatively minor, ranging from 1% to 8% of reported DBS procedures [2].
Who cannot undergo DBS?
DBS has minimal contraindications, most patients cleared for DBS can safely undergo the procedure. However, patients who are unable to operate the neurostimulator are not recommended to get DBS surgery.
However, once implanted, patients with DBS devices cannot undergo MRI scans, transcranial magnetic stimulation, or diathermy, a medical treatment that uses heat [4]. If an MRI is necessary, you should inform your doctors about the implanted devices so that they can adjust the machine settings to avoid disturbing the device.
Frequently Asked Questions
Can DBS cure my condition?
DBS is not a cure for your condition, it is a treatment that can greatly improve your symptoms. Diseases such as Parkinson’s disease will still progress even with DBS.
How long does the device battery last?
The battery specification will depend on the device. The typical battery life span can last around 3 to 5 years. Rechargeable batteries may last up to 9 years. It is important to check and consult with your neurologist regularly.
Will the DBS device be visible?
The devices and wires are all implanted beneath the skin, it may be noticeable in certain scenarios, such as on a thin person or a bald person it may appear as bulges under the skin.
Can I go through airport scanners with a DBS device?
You should notify airport security of your DBS device before going through an airport scanner. Additionally, you may request your neurologist to write a letter for you.
How long is life expectancy after DBS?
Studies showed that up to 51% of patients with Parkinson’s disease who underwent DBS surgery survived for at least another 10 years [5]. It is important to note that DBS surgery does not halt the disease progression, and life expectancy also depends on other factors such as the patient's age, disease stage, and general well-being. DBS provides significant relief from symptoms that may otherwise disable patients.
Is DBS surgery painful?
DBS surgery is done under anaesthesia, where pain and discomfort associated with the surgery is greatly minimised. Temporary pain may be present a few hours after the surgery was performed, however this can be managed with the use of pain medication.
Lee DJ, Lozano CS, Dallapiazza RF, Lozano AM. Current and future directions of deep brain stimulation for neurological and psychiatric disorders. J Neurosurg. 2019 Aug 1;131(2):333-342. doi: 10.3171/2019.4.JNS181761. PMID: 31370011.
Graat I, Figee M, Denys D. The application of deep brain stimulation in the treatment of psychiatric disorders. Int Rev Psychiatry. 2017 Apr;29(2):178-190. doi: 10.1080/09540261.2017.1282439. Epub 2017 Feb 10. PMID: 28523977.
Pycroft L, Stein J, Aziz T. Deep brain stimulation: An overview of history, methods, and future developments. Brain Neurosci Adv. 2018 Dec 12;2:2398212818816017. doi: 10.1177/2398212818816017. PMID: 32166163; PMCID: PMC7058209.
Hitti FL, Ramayya AG, McShane BJ, Yang AI, Vaughan KA, Baltuch GH. Long-term outcomes following deep brain stimulation for Parkinson's disease. J Neurosurg. 2019 Jan 18;132(1):205-210. doi: 10.3171/2018.8.JNS182081. PMID: 30660117.
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