Deep Brain Stimulation
Deep Brain Stimulation (DBS) is an FDA-approved treatment to correct abnormal electrical activity in the brain that causes neurological movement disorders, including Parkinson's disease, dystonia (characterized by muscle spasms) and essential tremor (characterized by uncontrollable movements). For patients whose symptoms are not controlled by medication alone, DBS is safer and more effective than older surgical procedures. The specific placement of the device within the brain determines the symptoms it relieves.
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Parkinson's disease is caused by failure and deterioration of nerve cells in dopamine-producing areas of the brain that control movement. Symptoms of Parkinson's disease include tremors, stiff and aching muscles, slow or limited movement (bradykinesia), weakness of the face and throat muscles and difficulty with walking and balance. There is no one test that can be used to diagnose an individual with Parkinson's. In order to determine the appropriate diagnosis, a doctor will complete a thorough medical history and neurological exam. Blood tests and a CT scan may be used to rule out other conditions with similar symptoms.
Dystonia is a chronic disorder characterized by involuntary muscle contractions that force the body into repetitive and often twisting movements as well as awkward, irregular postures. The cause of dystonia is related to a malfunction of the neurological mechanism that makes muscles relax when they are not in use. Dystonia can affect anyone at any age. As with Parkinson's disease, there is no single test to diagnose dystonia, but rather the observation of symptoms accompanied by a thorough patient history.
Essential Tremor is a nerve disorder that is characterized by uncontrollable shaking, or "tremors," in different parts and sides of the body. Tremors often occur in the hands, arms, head, larynx, tongue and chin. It is thought that the abnormal brain activity that causes essential tremor is processed through the thalamus, a deep area of the brain that coordinates and controls muscle activity. Essential tremor is genetically caused in 50 percent of cases. It generally strikes an individual first in middle age (40-50) and symptoms become more pronounced with age. There is no single lab test to diagnose essential tremor, but your doctor will use reported symptoms and a neurological exam to properly diagnose your condition.
How Does DBS Work?
DBS uses electrical impulses to stimulate a targeted area of the brain, providing specific symptom relief for each of the above conditions. The placement of the device's electrodes varies by condition and individual in order to affect the area that will provide the patient with the greatest symptom relief. For example, electrodes are placed in the thalamus in patients with essential tremor to control their abnormal muscle activity.
The device comprises two main components, the tiny wire electrodes that are placed in the brain and a small generator similar to a pacemaker that is implanted in the chest. The function of the generator is to create an electric field that blocks the brain's erratic electrical signals, relieving tremors and other symptoms associated with neurological disorders. The device can be turned on and off at any time by holding a magnet over the generator or through a small remote. When on, the device sends 100 to 180 electrical impulses per minute to stimulate a specific area of the brain. The DBS device is programmed to deliver the appropriate level of stimulation to provide each patient with the greatest relief of symptoms.
Implanting the DBS device generally requires two separate procedures, each of which lasts a few hours. The use of advanced imaging techniques has significantly improved the proper placement of electrodes in the target area of the brain. Recovery usually involves an overnight stay in the hospital following surgery.
Deep brain stimulation provides a safer and more effective treatment option for patients struggling with Parkinson's disease, essential tremors and/or dystonia. The primary advantage of DBS is that it does not destroy any brain tissue. Electrical stimulation is not only adjustable, but with the use of four electrodes it also allows the device to affect a larger area and provide a higher chance of relief. The DBS system provides a flexible and non-permanent option that puts the control in the hands of the patient.