Deep Brain Stimulation : A Pacemaker For The Brain
This is not the stuff of science fiction, but when you come to know about deep brain stimulation (DBS), you may think so. This is a neurosurgical procedure that appears to help people with a range of neurological disorders. DBS is presumed to help transform dysfunctional circuits in the brain so that the brain can function more efficiently. This is accomplished by placing a neurostimulator in the brain which sends out electrical impulses to specific parts of the brain. The impulses can obstruct anomalous signals that can underlie a range of neurological conditions. The DBS therapy is similar to that of a cardiac pacemaker in which the pacemaker helps keep up a proper cardiac rhythm. The process involves sending continuous electrical signals to specific target areas of the brain, which block the impulses that cause neurological dysfunctions. These targets are the ventralis intermediate nucleus of the thalamus (Vim), the subthalamic nucleus (STN) and the globus pallidus pars interna (GPi)
Deep brain stimulation (DBS) is generally used for movement disorders, treat Parkinson’s disease, dystonia (a movement disorder in which the muscles contract and spasm), treatment resistant depression (TRD) and essential tremors. It has been studied as a possible treatment for Tourette syndrome and more recently, obsessive-compulsive disorder. It's also approved for use by the U.S. Food and Drug Administration to reduce seizures in difficult-to-treat epilepsy.
How does it work?
Movement-related disorders (and certain neurological conditions) are caused by chaotic electrical signals in the regions of the brain that manages movement which lead to a breakdown in the normal flow of neurological messages resulting in involuntary muscle movement. The successful DBS therapy delivers electrical stimulation to targeted areas in the brain, blocking the abnormal nerve signals that cause abnormal symptoms. After a series of tests that determines the optimal placement, neurosurgeons implant one or more wires, called “leads (or electrodes),” inside the brain. The leads are connected with an insulated wire extension to a very small internal pulse generator or neurostimulator (similar to a heart pacemaker and approximately the size of a stopwatch) fixed under the person’s collarbone or in some cases it may be implanted under the skin over the abdomen or in the chest. Electric current pulses from the neurostimulator pass through continuously from the leads and into the brain.
After the neurostimulator has been in place, the doctor programs it to deliver optimal electrical stimulation. Programming generally begins a few weeks after the DBS procedure and may take more than one visit over a period of weeks or months for adjusting the neurostimulator settings and providing effective results. In adjusting the device, the doctor seeks an optimal balance between improving symptom control and limiting side effects. The battery can last three to five years depending on the application. During the replacement of the battery, the IPG is also replaced, in an outpatient procedure usually under local anesthesia. There is also rechargeable neurostimulator that lasts longer but needs regular recharging.
DBS Surgery Advantages
For control of symptoms, DBS can be performed on both sides of the brain affecting both sides of the body and the effects are reversible which can be tailored to a patient’s clinical status. Stimulation parameters can be attuned to minimize potential side effects and improve effectiveness over time. Patients who have been treated with DBS are still candidates for other treatment options and future alternative surgical approaches such as gene therapy or stem cell when they become available.
Dr. Hrishikesh Chakrabartty works as a consultant Neurosurgeon focused on functional Neurosurgery. Dr. Hrishikesh’s area of expertise includes DBS surgery for movement disorders like Parkinson's Disease as well as other psychiatric problems, Spinal cord stimulation (SCS), Intrathecal baclofen (ITB) pumps, Sacral nerve stimulation for sphincter disturbances, Surgery for chronic pain, surgery for bladder disturbances, Epilepsy surgery including temporal lobectomy and vagal nerve stimulation and more. He is the best for deep brain stimulation treatment in India.
Dr Manish Vaish - Neurosurgeon
Neurosurgeon NCR, Delhi
Dr. Yashpal Bundela MS Mch
Dr.Girish Rajpal MS Mch FINR
Dr. Shiwani Jain MD FNB
Senior consultant Neuroanesthesia, pain and critical care
Dr Hrishikesh Chakrabartty
Senior Consultant Neurosurgeon
Dr.Praveen Kumar MS Mch
Senior Consultant Neurosurgeon
Dr. Manish Marda MD DM
Head of Neuroanesthesia, pain management and critical care