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Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) is a technique involving the insertion of an electrode into particular areas of the brain and stimulating them with minute electrical currents from a special external pacemaker-like device. The ‘deep’ comes from the locations within the brain that are targeted; usually portions of the basal ganglia. The stimulating electrical currents override abnormal signals being produced by injured or diseased nerve cells, thereby suppressing the symptoms the abnormal signals were causing, which are most often abnormal movements. Where as DBS is not a curative procedure, it can have a dramatic effect on symptoms and day-to-day function of the patient by reducing abnormal movements.

Technique:
Careful positioning of the electrode is essential, and is achieved by three dimensional targeting with X-rays and by measuring the local electrical activity of the nerve cells through which the electrode passes. Each group of cells has its own signature firing pattern that can be recognized and aids in localizing the tip of the electrode within the brain.

Uses:
DBS is primarily used for the treatment of advanced Parkinson's Disease, particularly those patients who have disabling tremor. It has also been used for severe Essential tremor.

DBS


Recordings during DBS surgery (green lines right lower)

Summary:

Upside:

  • Non-destructive.
  • Can be modulated to the degree of symptoms present.

Downside:

  • Suppressive therapy only.
  • Can be complicated by bleeding at the site of the electrode insertion.
  • Requires leaving a foreign body within the brain and skull which has attendant risk of infection.

Last Word on DBS:
DBS is an extremely useful tool for the treatment of Parkinson's Disease and especially tremor due to Parkinson's Disease. It is being investigated and used in some centers for other disorders, including certain psychiatric disorders.

On line Resources:
Medtronic (manufacturer of DBS equipment)
Parkinson's Disease Foundation