By: Dr. Sharon Elza Raju, BDS, MHA, LSSGB, PMEC and Natalie L. Boehm, MBA, RBLP-T
What is Deep Brain Stimulation
According to the American Association of Neurological Surgeons, deep brain stimulation (DBS) is an elective surgical procedure in which electrodes are implanted into certain brain areas. The electrodes are implanted in specific areas of the brain to control and prevent abnormal brain activity. An implantable pulse generator is placed under the skin in the upper chest.
What makes up a Deep Brain Stimulation Device?
According to Cleveland Clinic, the deep brain stimulation system consists of four parts:
- Leads (thin insulated wires) that end in electrodes that are implanted in the brain
- A small pacemaker-like device, called a pulse generator, that creates electrical impulses
- Extension leads that carry electrical pulses from the device and are attached to the leads implanted in the brain
- Hand-held programmer device that adjusts the device’s signals and can turn the device off and on.
(Cleveland Clinic, 2019)
Who qualifies for Deep Brain Stimulation Device?
According to Mayo Clinic, brain stimulation is used to treat conditions such as Parkinson’s disease, potential tumors, dystonia, epilepsy, and obsessive-compulsive disorder. Doctors will see how high the risk is for any patient before recommending the procedure. Doctor will map areas of the brain to see where the electrodes need to be placed.
DBS vs. RNS vs. VNS
Deep brain stimulation is just one of many devices that can be used to control seizures when medication fails. Depending on the area of the brain that is affected, and type of seizure activity is taking place, physicians will decide what device is best of the patient to control seizure activity. Other options are vagus nerve stimulation (VNS) and responsive neurostimulation (RNS). In the article, Different modalities of invasive neurostimulation for epilepsy, the authors go into detail on what will qualify a patient to receive a device, how it works, data that has been collected over time, and any risks that can occur. Just like medication, what works for one patient might not work for another. It is important based on the patient’s medical history to take everything into account before deciding which route to take.
Risks
Just like any other surgery, there is a risk in receiving a deep brain stimulation device. Risks may include:
- 1% risk of brain hemorrhage, including stroke
- Infection
- Device malfunction
- Lack of benefit for certain symptoms
- Headache
- Worsening mental or emotional status
(Pilitsis et. al., 2021)
Additional surgery risks include:
- Misplacement of leads
- Breathing problems
- Nausea
- Heart problems
- Seizures
(Mayo Clinic, 2021)
Potential Side Effects
After having a deep brain stimulation device implanted, patients experience difference side effects. Side effects can be mild to serious. Side effects may include:
- Temporary tingling in the face of limbs
- A feeling of pulling in muscles
- Speech or vision problems
- Loss of balance
(Pilitsis et. al., 2021)
Additional side effects are:
- Seizures
- Infection
- Headache
- Confusion
- Difficulty concentrating
- Stroke
- Hardware complications, such as an eroded lead wire
- Temporary pain and swelling at the implantation site
(Mayo Clinic, 2021)
Call your physician at once if you experience the following:
- 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
(Cleveland Clinic, 2019)
It is important to follow up with your physician and follow your recovery plan to increase the chance of having a successful procedure. Communication with your physician is essential so keep a journal of any side effects or symptoms you are experiencing. Adjustments made need to be made on how frequent your device goes off to control seizure activity. Your physician will make adjustments as needed.
Conclusion
Deep brain stimulation (DBS) is an elective surgical procedure in which electrodes are implanted into certain brain areas. Conditions such as Parkinson’s, dystonia, and epilepsy can be treated with deep brain stimulation. Deep brain stimulation is considered for patients who are drug resistant. Depending on the area of the brain that is affected and what type of seizures are taking place will determine what device a patient can benefit from. Like other surgeries, there are risks and it is essential to listen to your physician when it comes to recovering and letting them know if any complications are taking place.
Resources:
Alomar, S.A., & Saeedi, R.J. (2020). Different modalities of invasive neurostimulation for epilepsy. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(12), 3527-3536. https://doi.org.proxy.westernu.edu/10.1007/s10072-020-04614-z
Cleveland Clinic (2019). Deep Brain Stimulation. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation
Mayo Clinic (2021). Deep Brain Stimulation. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562
Pilitsis, J.G., Khazen, O., and Patel, S. (2021). Deep Brain Stimulation. American Association of Neurological Surgeons. Retrieved from: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Deep-Brain-Stimulation
