Deep brain stimulation (DBS) is the term for a medical procedure that involves the implantation of a battery-operated device designed to provide stimulation to targeted regions of the brain. It works by delivering electrical impulses in a manner similar to a pacemaker. The goal of this innovative therapy is to override abnormal neurotransmissions that generally occur due to insufficient production of dopamine, the feel good hormone manufactured in the brain that also regulates muscle coordination and movement.
While deep brain stimulation is not a sure-fire cure for any condition, it has been shown to be a highly effective treatment for a variety of neurological disorders. In the US, deep brain stimulation is the Food and Drug Administration (FDA) approved standard treatment for advanced Parkinson’s disease, kinetic tremor (also called an essential tremor) and dystonia. In recent years, deep brain stimulation therapy has also been applied to conditions associated with chronic pain and psychological disorders, including major depression. However, since deep brain stimulation is an invasive procedure, it is generally reserved for patients with severe symptoms that do not respond favorably to conventional treatments or medication.
Deep brain stimulation as it exists today was born out of surgical procedures first performed in France in the late-1980s known as lesioning. The idea was to cauterize and permanently disable specific areas in the brain where tremors are known to stem from. These are the same areas of the brain targeted by deep brain stimulation, but they are stimulated with electrical impulses instead of being destroyed.
As one can imagine, deep brain stimulation is a delicate procedure requiring significant surgical skill. It begins with threading a lead wire with four electrodes only a millimeter (almost 4 hundredths of an inch) thick deep into one of three regions of the brain, depending on the condition being treated. The electrodes are then connected to a secondary wire running from the skull, behind the ear, down the neck, and finally to the battery-operated neurostimulator usually implanted in the upper chest, although sometimes it is placed in the abdomen instead. For the next several weeks, or even months, the device is calibrated by the medical team in order to achieve the maximum benefit. After this period of adjustment, the patient can control the settings by himself or herself.
Deep brain stimulation, like any surgical procedure, can present certain risks. Undergoing anesthesia and surgery alone, may trigger a stroke, a heart attack, or breathing irregularities in some individuals. Other complications, such as excessive bleeding from the brain or infection, may also occur. In addition, deep brain stimulation may promote the development of long-term problems in some people, such as mood swings, seizures, or involuntary movements. In addition, while the majority of patients who undergo deep brain stimulation experience significant relief of symptoms and improved quality of life, not every case of depression or Parkinson’s disease responds positively to the treatment.
