22 Feb Deep Brain Stimulation: How Does DBS Surgery Work | What to Expect?
Deep brain stimulation is a highly researched electrical stimulation treatment for various neurological disorders.
Though it comes as the last resort for treating such disorders, doctors usually recommend it when the medications stop yielding desired effects.
Some of the disorders that have DBS as the last treatment option include tremor, dystonia, and even Parkinson’s disorder.
However, despite the complex system that the surgery uses, it doesn’t guarantee a complete cure. With that, DBS surgery mainly improves the quality of life.
Since the process involves elective surgery, brain stimulation is often questioned regarding the efficacy and adverse scenarios.
In the following sections, we cover an in-depth analysis of the deep brain stimulation success rate and side effects too!
What is Deep Brain Stimulation Used For?
DBS, when used as a surgical tool, commonly affects the pathological activity of the brain and stimulates various regions of the brain for therapeutic effects.
Its therapeutic uses mainly aim at treating neurologically induced movement disorders like:
#1. Parkinson’s Disease
Deep brain stimulation surgeries for PD target two key structures:
- STN, a motor relay structure that causes symptoms of Parkinson’s
- GPi (Globus Pallidus Internus)
However, most of the studies show that the surgery has a higher success rate when it targets the STN as this helps relieve the symptoms.
#2. Dystonia
Dystonia is a condition characterized by muscle spasms and postural instability because of neurological dysfunction.
Earlier there were too many contradictory opinions on using DBS for dystonia. But now it has come out as the first-line treatment option.
The DBS used for dystonia targets the GPi located in the posteroventral lateral area of the brain.
However, it can take quite a time to show results, but these results produce long-lasting effects.
#3. Tremor
Generally, tremors involve shaky movements in different parts of the body.
Deep brain stimulation often works as a treatment for tremors.
In fact, tremor was the first disorder for which the FDA approved using DBS, and it is now a routine treatment plan for tremors.
For treating tremors, DBS either targets the fibers directly or stimulates the subthalamic region.
#4. Tourette Syndrome
Tourette Syndrome causes repeating movements or making unwanted sounds. Symptoms usually start in childhood.
DBS targets the basal ganglia and the malus when it comes to treating this disorder.
Moreover, other than movement disorders, DBS also works for various other disorders including:
- Pain
- Epilepsy
- Depression
- Bipolar disorder
- Obsessive-compulsive disorder
- Anorexia nervosa
- Alzheimer’s
However, DBS is not very popular for treating pain.
Despite the wide range of therapeutic benefits of Deep Brain Stimulation, there are still questions on what is the success rate of deep brain stimulation and does it work.
So far, only research and clinical evidence can answer that.
Does Deep Brain Stimulation Work?
Till now, nearly every research shows that deep brain stimulation usually relieves the symptoms and improves the quality of life.
In short, it’s not an absolute cure as per some reports.
Study I – How Does DBS Work for Parkinson’s?
This study was conducted by Aryn Gittis, studying Parkinson’s disease since 2008 and researching it since 2012, starting at Carnegie Mellon University.
The basic model observed how different neurons react to deep brain stimulation.
After turning on the stimulation, neurons showed contrasting activities. For example, some neurons showed exciting properties, though some became slow.
However, when the stimulation continued for a few seconds, all the neurons showed an increase in speed.
This suggests that using the stimulation correctly or using it as the burst method rather than the continuous method can yield a long-lasting therapeutic response among PD patients.
Hence, the study showed that using the right method of DBS can yield good activity among PD patients by speeding up the neurons.
Study II – Study on DBS for Post-Stroke Rehabilitation
The study was an open-label observation conducted at the Cleveland clinic comprising of 12 patients suffering from:
- Chronic
- Moderate
- Severe
…hemiparesis of the upper extremity and middle cerebral artery.
These patients, during the study, went under three months of rehabilitation before being given the stimulation.
Post completion of three months, the patients were given rehabilitation combined with Deep Brain Stimulation.
The results showed patients showing improvement in the quality of life post the DBS treatment.
Study III – DBS and Psychiatric Disorders
A study was published in the Frontiers showing good responses of patients suffering from psychiatric disorders like autism when subjected to stimulation.
However, the study observed only 5 patients seeking DBS for obsessive-compulsive disorder from 2015 to 2019.
The results showed that there was a significant improvement in the symptoms and mood swings post DBS.
There are many other animal studies too that provide affirmations on the working capability of deep brain stimulation surgery.
Hence, current evidence confirms that brain stimulation surgery might actually be of some use to alleviate severe symptoms not responsive to medications.
Talking more about whether the surgery can yield prominent results, it’s the working that defines results.
Thus, next, we talk about the entire working mechanism that the DBS surgery follows to achieve a successful outcome.
How Does Deep Brain Stimulation Work?
Deep brain stimulation works by interfering with irregular signals that can cause any movement disorder.
For example, among the major symptoms of Parkinson’s disease is the cortisol imbalance, which is responsible for regulating the correct transmission of signals.
These signals further control the movements.
Due to irregular signals, your movements are not under the right control, leading to severe signs of PD.
When the DBS device is inserted correctly, it interrupts these signals.
This is possible because of the continuous electric pulses that the whole DBS system passes into the brain.
For more clarification on how these electric pulses are generated, we study the DBS surgery closely below.
What is a DBS Surgery | How Does Deep Brain Stimulator Work?
The entire surgery comprises placing electrodes or leads into specific regions of your brain based on the disease you are seeking therapy for.
These electrodes then give rise to electrical impulses, which balance chemicals and neuronal stability within the brain.
The three components used in the surgery are:
#1. Electrodes
The electrodes are implanted in your brain by drilling through your skull after injecting numbing medicines to the scalp.
Brain mapping helps find the right placement area prior to the insertion of these electrodes.
Mapping involves taking neurophysiological recordings using very thin electrodes inserted into the brain. The use of numbing medicines or local anesthesia is common during this procedure.
Local anesthesia numbs only the part of the scalp before the insertion of the electrodes while keeping the patient awake.
This of course helps in locating the sites better.
Once located, the electrodes are inserted and connected to the neurotransmitters.
#2. Neurotransmitter
During connecting neurotransmitters, your doctor will give you anesthesia to keep you sleeping while the surgery goes on.
The neurotransmitter is usually placed under superficial layers of the skin, or it could be under your beauty bone.
Next, there is the laying of a wire connecting the electrodes in your brain and the neurotransmitter under your skin layers.
Once the neurotransmitter is in the right place, it is programmed to send electrical impulses.
However, the programming starts after a week of placing the transmitter.
The final step, programming, is the core of the whole setup and is time-consuming.
#3. Programming
Programming requires lots of adjustments to finally get the best setting for the patient.
Hence, it would require your periodic visits to the doctor and even some medication adjustments.
Sometimes, the wrong placement of the leads or rupture of any vessels can even lead to complications and side effects of the surgery.
Deep Brain Stimulation Side Effects and Complications
Just like any other surgery, deep brain stimulation has its risks, complications, and even side effects.
The Side Effects of Deep Brain Stimulation
Side effects usually appear weeks after the surgery and can be because of wrong programming before finding the best setting.
These side effects usually improve and diminish once your doctor finds the perfect setting for you.
Some of these DBS side effects can be:
- A tingling sensation around your face and other parts
- Dizziness and instability
- Problems in focusing or weak alertness
- Blurred vision
- Less coordination in your body than before
- Jolting sensation
While the side effects aren’t much concerning, the surgery can have some serious complications if not done with precision.
Complications | Long-Term Side Effects of DBS (Deep Brain Stimulation) Surgery
There are mainly two types of complications with DBS:
1. Surgical Complications – These complications can be due to choosing the wrong landmark for anesthesia, rupturing any blood vessels during insertion of the electrodes.
It could also be because of the wrong placement of the electrodes.
Some common surgical complications are:
- Adverse reactions of anesthesia
- Wrong injection technique causing inflammation at the site of injection
- Rupture of blood vessels in the brain leading to hemorrhage
- Allergies to any part of the implanted device
2. Hardware Complications – This could be because of the impaired functioning of the inserted device. For example, dysfunction of any part of the lead or failure of the wire to conduct impulses.
It can also be due to battery failure of the neurotransmitter or the incorrect placement of the neurotransmitter.
There are also other risks of deep brain stimulation surgery depending on the medical history of the patient.
Despite all these side effects and complications, DBS doesn’t pose any serious threat to your brain.
Does Deep Brain Stimulation Damage the Brain?
According to a study conducted over 8 PD patients undergoing deep brain stimulation targeting:
- Thalamic ventral intermediate nucleus
- Subthalamic nucleus
All these patients were undergoing the surgery for 70 months.
Observations of neural parenchyma of the brain concluded no particular changes.
This proved that chronic DBS doesn’t cause any damage to the brain.
Unfortunately, despite some good benefits and possibly healthy outcomes of DBS, the surgery doesn’t work the same for all patients.
It can benefit some people more than others while for some it could just relieve minimal symptoms.
Who is a Good Candidate for Deep Brain Stimulation?
Deep brain stimulation surgery is time-consuming with lots of consultations and pre-surgery tests requiring a lot of effort
Thus, you should have enough time on your hands to engage in the whole surgery process.
Furthermore, the deep brain stimulation cost is pretty much higher than any other surgery. Even today, only well-off families can afford it because of the tests and the components.
Apart from these, the following groups of people can gain maximum benefits out of the surgery:
- Patients that don’t respond well to the medications
- People who respond only to high doses of medications
- Patients suffering from tremors and diagnosed with Parkinson’s disorder
- People showing twisting movements or uncontrolled postural abnormalities
- Touretter syndrome patients
So, with the surgery finally over and you finally get to know exactly how does Deep Brain Stimulation (DBS) works, you might wonder what’s next.
What to Expect after DBS Surgery?
Life usually doesn’t return to normal post-surgery as it requires special care and precautions.
Post DBS surgery, you are just kept under observation for 24 hours to notice any sign of complications.
Once the time frame gets over, you can return home but would need to follow some savior tips like:
- Always go out with a proper identity card that proves you carry a neurostimulator
- Make sure you inform the airport security about your neurostimulator to avoid any unnecessary metal detection. Also, ask the security not to use their detectors over your machine for a longer period as the magnet used can damage the neurostimulator.
- Avoid going to places that have huge magnetic fields
- Make sure you don’t get any physical trauma around the area your neurotransmitter is placed at as that could cause impaired functioning.
- You won’t be able to get an MRI scan because of the high magnetic fields the neurotransmitter generates.
Final Word
Deep brain stimulation surgery is one of the trusted surgeries for movement disorders caused by neurological impairments.
DBS surgery is most commonly useful for Parkinson’s, that too when the tremors become severe.
Sometimes, DBS is also helpful in cases of pain and even psychiatric disorders.
Although the surgery is usually safe and shows side effects during programming, 1% of cases can also show complications like hemorrhage.
Talking about how long does deep brain stimulation last it could last till the time the stimulation is on, or even after the stimulation is off.
It depends on the type of DBS you go for.
But in most cases, the results are long-lasting and improve the quality of life.
Hopefully, you have got something out of this post and now have a fair understanding of how does deep brain stimulation work and what is the process of surgery. Drop any more queries down below to get personal advice.
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