What you need to know about:

Deep brain stimulation (DBS)

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Average Cost:

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Recovery Period:

1-2 days

Permanence:

Depends on patient condition

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Doctors

Time it takes:

4-6 hours

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Anesthetize:

General Anesthesia

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Overview of

Deep brain stimulation (DBS)

in Thailand

Deep brain stimulation (DBS) is a surgical treatment procedure in which a brain pacemaker is implanted to deliver electrical impulses to specific parts of the brain. This procedure is used to treat tremors, Parkinson's disease, dystonia and who can’t adequately control their disease with medication. For those with Parkinson’s, DBS can reduce tremors and significantly improve slowness and stiffness; and make tremors disappear for those with ET. DBS can help relax muscles and improve abnormal postures caused by muscle contractions for those with dystonia. In all cases, DBS can help enhance quality of life. It’s important to understand that DBS does not offer a cure for your disease, but a way to manage it more effectively. It can offer many benefits, including the need to take less medication and therefore experience fewer medication side effects.

Goals of

Deep brain stimulation (DBS)

Deep brain stimulation can provide continuous brain stimulation, which controls abnormal movements (shaking, twisting, stiffness and slowness) more effectively than treatments with medication. It is an established treatment for people with movement disorders, such as essential tremor, Parkinson's disease and dystonia, and psychiatric conditions, such as obsessive-compulsive disorder. It's also approved for use by the Food and Drug Administration to reduce seizures in difficult-to-treat epilepsy. This treatment is reserved for people who aren't able to get control of their symptoms with medications.

Price of

Deep brain stimulation (DBS)

Average Cost

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Price Range

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Pros and cons of

Deep brain stimulation (DBS)

Pros

-Reduction of Adverse Symptom: DBS often reduces symptoms significantly such as motor symptoms like stiffness, tremor, slowness, and Dyskinesia. DBS has also been shown to aid in on/off fluctuations, improve mood and quality of life, and increase overall energy levels. -No need to remove Nerve Cells: DBS does not require your nerve cells in your brain to be removed. -Decreased Medication: DBS surgery helps to decrease medication and as well as Levodopa side effects. -Individualized Treatment: Electrodes and stimulation frequency and intensity can be controlled by physicians and the individual with DBS, and can be subjectively altered when needed. -Independent Life: Due to Parkinson disease, tremor, any movement disorder or dyskinesia, the patient depends on the other for their daily activities also. DBS surgery helps to control the symptom and allow people to do by himself.

Cons

-Risk of Surgery or Surgical Side Effects: The risk of bleeding, stroke, infection, and accumulating fluid in the brain must always be considered. -Results are not Immediate: It will take months to work out the precise balance of DBS stimulation and medications to optimally management symptoms. Whereas certain symptoms could subside soon, it may take an extended quantity of your time to seek out the proper combination for long-term effects. -Invasive and Awake during Procedure: DBS surgery will involve an incision in the scalp, and access to deep elements of the brain. Additionally, individuals are awake during the procedure. -Future Danger around Certain Electronics: Basic electronics are usually fine for those with DBS to be around, however, larger, more powerful machines, like a total body coil MRI, may be contraindicated for DBS

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How It Works:

Deep brain stimulation (DBS)

The brain pacemaker is implanted by a functional stereotactic neurosurgeon. This means that a stereotactic head frame is used to keep the patient’s head still during surgery and the neurosurgeon uses special imaging techniques, such as magnetic resonance imaging (MRI) or computed tomography (CT), to map the brain and locate the position of the site to be stimulated. There are two parts to the surgery: 1. Brain surgery portion. For the brain surgery portion, your care team fits you with a special head frame to keep your head still during the procedure (stereotactic head frame). Then, team members use magnetic resonance imaging (MRI) to map your brain and identify the area in your brain where they'll place the electrodes. Surgery can be done under general anesthesia so that you'll be unconscious. Or the procedure can be done with you awake and alert. If you're awake for surgery, you'll be given a local anesthetic to numb your scalp before the procedure, but you won't need an anesthetic in your brain itself because the brain has no pain receptors. Your surgeon implants a thin wire lead with a number of contacts (electrodes) at the tips into a specific area of your brain. Or one lead is implanted into each side of the brain (for a total of two leads). A wire runs under your skin to a pulse generator (neurostimulator) implanted near your collarbone. During surgery, both the neurologist and surgeon carefully monitor your brain to help ensure correct electrode placement. 2. Chest wall surgery portion During the second portion of the surgery, the surgeon implants the part of the device that contains the batteries (pulse generator) under the skin in your chest, near your collarbone. General anesthesia is used during this procedure. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated pulse generator. The generator is programmed to send continuous electrical pulses to your brain. You control the generator, and you can turn it on or off using a special remote control.

Preparation before

Deep brain stimulation (DBS)

Pre - treatment

Before surgery, you'll need medical tests to make sure that deep brain stimulation is a safe and appropriate option for you. You'll also need brain-imaging studies, such as an MRI, before the surgery, to map the areas of your brain to implant the electrodes.

Recovery after

Deep brain stimulation (DBS)

Post - treatment

A few weeks after surgery, the pulse generator in your chest is activated in your doctor's office. The doctor can easily program your pulse generator from outside your body using a special remote control. The amount of stimulation is customized to your condition, and may take as long as four to six months to find the optimal setting. Stimulation may be constant, 24 hours a day, or your doctor may advise you to turn your pulse generator off at night and back on in the morning, depending on your condition. You can turn stimulation on and off with a special remote control that you'll take home with you. In some cases, your doctor may program the pulse generator to let you make minor adjustments at home. The battery life of your generator varies with usage and settings. When the battery needs to be replaced, your surgeon will replace the generator during an outpatient procedure.

Risks & side effects

Pins and needles; tingling sensations Feeling an electric shock Muscle cramps or contractions Abnormal movement Potential surgical complications and risks Paralysis, coma, death Intracranial hemorrhage Leakage of cerebral fluid surrounding the brain Seizures Infection Allergic reaction to the implanted materials Temporary or permanent neurological complications Confusion or attention problems Pain at the surgery site Headaches

FAQs:

Deep brain stimulation (DBS)

What kinds of patients can be considered for this procedure?

‍Advanced Parkinson’s Disease with inadequate control by medications or with intolerable adverse effects from medications. Essential Tremor with inadequate control by medications or with intolerable adverse effects from medications. Dystonia with inadequate control by medications or with intolerable adverse effects from medications.

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When is a good time to consider DBS? Am I a good candidate?‍

There are somewhat different criteria for determining if DBS is a good option for you based on your diagnosis and condition. For Parkinson’s disease, DBS is typically helpful if you experience motor fluctuations or tremors that interfere with activities that are not already adequately managed by medication, are not improved by changes in medication, or you experience side effects that prevent you from taking higher doses. For ET, DBS may be considered if you have tremors that interfere with your quality of life and cannot be controlled adequately with medications. Other key factors considered are age in combination with general health, a solid support system of family and friends, absence of dementia or an active psychiatric illness such as severe depression, and realistic expectations for treatment outcomes.

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What does DBS feel like when the device is on?

‍During the initial programming of the DBS, individuals may experience a slight, temporary shock or tingling as placement and levels are adjusted. Identifying the best placement and level enables you to receive the greatest benefit possible based on your unique condition and needs. Most individuals feel little if any sensation at all during normal use. For the few that do, it is described as a slight tingling down an arm or leg, or mild facial pulling which subsides. This is more common in individuals using DBS for essential tremor as the device can be turned off at bedtime.

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