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Deep brain stimulation (DBS) is used to treat a number of movement
disorders including essential tremor. DBS is a way to inactivate the thalamus,
a structure deep in the brain thought to be responsible for the tremor, without
purposefully destroying parts of the brain.
DBS is preferred over thalamotomy. Experts don’t know how DBS
suppresses tremors, but it may suppress them by disrupting the nerve activity.
The treatment of DBS is as effective as thalamotomy.
How does it work?
To treat essential tremor, electrodes are placed in the thalamus. The
electrodes are connected by wires to an impulse generator (IPG), which is
a type of pacemaker device that is implanted under the skin of the chest, below
the collarbone. Once activated, the device sends continuous, painless electrical
pulses to the thalamus in order to block impulses that cause tremors. This
treatment has the same effect as thalamotomy without actually destroying parts
of the brain.
The IPG can easily be programmed using a computer that sends radio signals to
the IPG. Patients are given special device so they can externally turn the IPG
on or off.
Depending on use, the stimulators may last three to five years. IPG
replacement procedure is relatively simple.
How effective is deep brain stimulation?
DBS provides moderate relief for approximately 90% of patients.
What are the pros and cons of deep brain stimulation?
Some advantages of deep brain stimulation:
- It doesn't destroy brain tissue and won't limit future
treatment.
- The device can be removed at any time.
- It is adjustable.
- It may be more effective in controlling tremors than
thalamotomy.
Some disadvantages of deep brain stimulation:
- The presence of a foreign object in the body may increase the
risk of infection.
- Repeat surgery may be required every three to five years in
order to replace the battery in the device.
- Uncomfortable sensations may occur during stimulation.
Who should consider DBS?
There are many important issues to be addressed when considering deep brain
stimulation. These issues should be discussed with a movement disorders
expert or a specially trained neurologist. A movement disorders expert is
someone who has trained specifically in movement disorders.
A person considering DBS should have had an adequate trial of medications.
Surgery is not recommended if medications can adequately control the disease.
However, surgery should be considered for people who do not achieve satisfactory
control with medications or experiencing major side effects. Talk to your doctor
to see if DBS is right for you.
What happens during the procedure?
Surgeons locate target areas of the brain on which they will place
electrodes. Most surgeons locate these areas with the help of CT (Computed
Tomography) or MRI (Magnetic Resonance Imaging), but some surgeons
use an electrode recording technique to map and target the specific areas that
they will need to reach.
Once the correct locations are identified, the permanent electrodes are
implanted. The loose ends are placed underneath the skin of the head and any
incisions are closed with sutures. One week later, the patient is re-admitted to
the hospital for a very brief time. Once the patient is placed under general
anesthesia, doctors disconnect wires from the loose ends of the electrodes and
connect those wires to impulse generators. Two to four weeks later, the IPG is
turned on and adjusted. It may take a few weeks after the simulators and
medications are adjusted before patients experience adequate symptom relief.
However, DBS causes very few side effects.
What are the risks?
As with any surgical procedure, there are risks. There is a two- to
three-percent risk of a serious and permanent complication such as paralysis;
changes in thinking, memory, and personality; seizures; and infection. In some
patients speech changes can also occur. Talk to your doctor to see if these
risks apply to you.
Will I be asleep during the procedure?
Throughout most of the procedure you will remain awake. This allows the
surgical team to interact with you when testing the effects of the stimulation.
Small amounts of local anesthetic (pain-relieving medication) are given
in sensitive areas. The vast majority of people experience minimal discomfort
during the procedure.
What should I expect after DBS?
You may feel tired and sore, but you will be given medication and kept
comfortable. Also, you may have irritation or soreness around the stitches and
pin sites.
As with any surgery, there are some guidelines and limitations that you
should follow after DBS. Be sure to discuss these topics with your doctor and
ask questions before surgery. Understanding what you will experience and knowing
what to expect afterward can help ease some of the natural anxiety that comes
with any medical procedure.
When will I be able to go home?
The average hospital stay for DBS surgery is two to three days.
How should I care for the surgical area once I am home?
- Your stitches or staples will be removed 7-10 days after
surgery.
- Each of the four pin sites should be kept covered with bandages
until they are dry. These should be changed every day as necessary.
- You will be able to wash your head with a damp cloth, avoiding
the surgical area.
- You may only shampoo your hair the day after your stitches or
staples are removed, but only very gently.
- You should not scratch or irritate the wound areas.
Will I have to limit my activity following DBS?
- You should not engage in light activities for two weeks after
surgery. This includes housework and sexual activity.
- You should not engage in heavy activities for four to six weeks
after surgery. This includes jogging, swimming or any physical education
classes. Anything strenuous should be avoided to allow your surgical wound
to heal properly. If you have any questions about activities, call your
doctor before performing them.
- You should not lift more than five pounds for at least two
weeks.
- Depending on the type of work you do, you may return to work
within four to six weeks.
Warning:
Call your doctor immediately if you experience any of the following symptoms:
- Severe and persistent headaches
- Bleeding from your incision
- Redness or increased swelling in the area of the incision
- Loss of vision
- A sudden change in vision
- A persistent temperature of 101 degrees Fahrenheit or higher
Can I use electrical devices?
While you should be able to use most electronic devices, you should be aware
that:
- Some devices, such as theft detectors and screening devices,
like those found in airports, department stores, and public libraries, can
cause your neurotransmitter to switch on or off. Usually, this only causes
an uncomfortable sensation. However, your symptoms could get worse suddenly.
Always carry the identification card given to you. With this, you may
request assistance to bypass those devices.
- You will be able to use home appliances, computers and cellular
phones. They do not usually interfere with your implanted stimulator.
- You will be provided with a device to activate and deactivate
your stimulator.
- Ask your doctor before you under go MRI or surgical procedures
for any other reasons.
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