What, How, And Why: An Introduction To Deep Brain Stimulation For Parkinson’s Disease

22 Aug 2018

We’ve all heard that the brain is like a big, complicated computer. But do you know how far this is true? The brain is truly a marvellous creation with many intricate structures and functions. Unfortunately, this also makes it prone to a number of disorders.

Parkinson’s disease is one such condition. Parkinson’s disease is a degenerative neurological condition in which there is a progressive loss of dopamine-producing neurons in the brain. This results in symptoms such as slowing of movements (bradykinesia), tremor, imbalance, walking difficulties, and mood disturbances. Parkinson’s disease can be managed with medication and other treatment modalities but there is no absolute cure.

One of the newest and most promising treatment options for Parkinson’s disease is Deep Brain Stimulation or DBS. 

Deep brain stimulation is a surgical treatment that is recommended for patients with Parkinson’s disease who have an incomplete response to medications or for whom medication no longer has any positive effect.

What Is Deep Brain Stimulation?

Deep brain stimulation is a surgical procedure in which a device that emits electrical signals is implanted into the body to control. The electrodes that deliver the electrical pulses is implanted in different parts of the brain depending on what the disease condition is.

Deep brain stimulation is most commonly used to manage conditions like Parkinson’s disease and essential tremor, and is also being tested for the management of psychiatric conditions like major depressive disorder and obsessive-compulsive disorder. 

How Does Deep Brain Stimulation Work?

The entire DBS system consists of three parts:

  • The pulse generator which is implanted (IPG)
  • The lead
  • The extension

The pulse generator is a stimulator encased in titanium that runs on batteries and sends out the electrical signals. The lead is an insulated wire with four electrodes made of a platinum-iridium alloy. These electrodes are placed in different regions of the brain. The extension is an insulated wire that connects the implanted pulse generator to the lead. The pulse generator is usually placed under the skin of the chest or below the collarbone and the extension runs up the back of the neck, under the skin.

The placement of the electrodes and the rate and intensity of the electrical stimulation depends entirely on the condition to be treated and the severity of symptoms.

For Parkinson’s disease, the electrodes are most commonly placed in two regions of the brain: the subthalamic nucleus and globus pallidus interna. These two areas are known to demonstrate the best result for the patient, i.e, reduction in severity of symptoms.

Deep brain stimulation has been approved as a treatment for Parkinson’s disease in 1997 but there are a limited number of hospitals in Bangalore for deep brain stimulation.

The exact mechanism of action of deep brain stimulation is not very well known. It is theorized that the electrical signals from the neurostimulator interfere with the incorrect signals in the brain which cause the disease symptoms. This interference is what reduces the severity of symptoms.

What Are The Risks Of Deep Brain Stimulation?

As with any surgical procedure, deep brain stimulation carries with it some degree of risk. Since the skull cavity needs to be opened, there is a chance for intracranial bleeding in the brain, trauma, stroke, seizures, and infection.

There is a very small chance that the leads or the wires get misplaced or incorrectly placed, but this is a very rare occurrence since utmost care is taken to ensure placement of the device is perfect.

After the surgery, some people have reported side effects such as mood disturbances, trouble with sleep, nausea, vomiting, swelling, and pain at the site of implantation. Regular follow-up sessions are scheduled to monitor side effects and the effectiveness of treatment.

Is Deep Brain Stimulation Right For Me?

If you or a loved one are thinking about deep brain stimulation as a treatment option for a neurological condition, the first step is to get evaluated by a neurologist at a hospital for DBS. There are a few hospitals that offer this services, mostly in metropolitan areas. The best hospital for DBS surgery is in Bangalore since the city has a few hospitals that provide DBS surgery and this allows you to compare costs and services before you make a decision.

A neurologist evaluates the patient before making a decision to use deep brain stimulation since this treatment may not be right for some people and other treatment modalities may be better. 

Remember, deep brain stimulation is not a cure, it is a treatment option. DBS doesn’t cure a person of Parkinson’s disease or other neurological conditions but helps them to better manage the symptoms. Each patient responds differently to treatment, with some having a complete reduction in symptoms and some people still needing to take additional medications to help control their symptoms.

At the end of the day, this is a personal decision between a person and their doctor. Deep brain stimulation is promising but doesn’t lose hope if it’s not right for you. There are many ways to manage these conditions and DBS is merely one of them.

Keep your options open and stay informed so that you can make the best decisions for your health.