Deep Brain Stimulation (DBS) is a surgical procedure used to treat severe essential tremor and tremor, rigidity and bradykinesia (slow movement) associated with Parkinson's disease.
The surgery involves craniotomy
for implantation of an electrode
into the thalamus
or basal ganglia
of the brain
. The electrode is powered by a battery-operated neurostimulator placed under the collar bone
. Electrical stimulation through the electrode interferes with neural activity
at the target site (usually specific areas of the thalamus or the subthalamic nucleus
of the basal ganglia) which can alleviate tremors, rigidity or bradykinesia.
The choice of target site depends on the symptoms being addressed. After the surgery is completed, an expert calibrates the unit in order to maximize its effectiveness. The programming of the neurostimulator can take up to a year to achieve an optimal setting.
Typically DBS is performed unilaterally on the side of the brain opposite to the side of the body most debilitated by the disease, but in many cases it is performed bilaterally in a single operation.
DBS has been found to significantly alleviate symptoms in two thirds of Parkinson's patients, and has recently been used more frequently to treat cases of severe essential tremor.
Although DBS is a procedure performed on the brain, it is FDA-approved in the United States and carries the risks of major surgery.
The post-surgical complication rate is proportional to the experience of the surgical team with a tipping point of 50 DBS procedures and a cushion of 100 DBS procedures.
Depending upon usage, the battery in the neurostimulator must be replaced after three to five years. Due to the necessity to maintain an uncontaminated field within the body, the entire unit must be reimplanted. Nevertheless, this is a minor surgical procedure involving only the shallow subclavicular pocket where the neurostimulator resides.
Remaining battery life may be reliably determined with a telemetric programmer so that arrangements can be made to replace the unit prior to battery failure.
Recent experimental tests have led researchers to hypothosize that DBS might have some benefit in the treatment of depression.
Last updated: 05-22-2005 15:54:26