Deep brain stimulation (DBS) involves implanting electrodes within certain areas of the brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or the electrical impulses can affect certain cells and chemicals within the brain.
Electrical stimulation of the nervous system is used in the treatment of movement disorders, pain, and epilepsy. Stimulation involves placement of an electrode, which is then connected to a subcutaneously placed generator.
Types of brain stimulation
The five main types of brain stimulation therapies used to treat mental illness are electroconvulsive therapy, vagus nerve stimulation, deep brain stimulation, repetitive transcranial magnetic stimulation, and magnetic seizure therapy.
Risks
- Invasive and awake during procedure: The procedure does involve an incision to the scalp, and access to deep parts of the brain. Additionally, most individuals are awake during the procedure, which could be a scary situation for some.
- Not all symptoms addressed: Typically, symptoms that would respond to levodopa respond the best to DBS. Other symptoms that aren’t managed by levodopa are generally unaffected.
- Surgical side effects: As with most surgical procedures, there are risks associated with surgery itself. These include the risk of bleeding, stroke, infection, and accumulating fluid in the brain. Also, since the brain is a complex and sensitive organ, it is possible for essential areas of the brain to get hurt during the procedure and cause additional symptoms unrelated to PD.
- Future danger around certain electronics: Basic electronics are usually fine for those with DBS to be around, however, larger, more powerful machines, like total body coil MRI, may be off-limits post-procedure.
- Malfunction and battery replacement: It is possible for the hardware to malfunction, wires to disconnect, and the electrodes to shift. Additionally, the battery life of the devices and controllers need to be monitored relatively frequently.
- Expensive: Although many insurance companies may cover part or all of DBS, the procedure can run anywhere from $30,000-$100,000.
- Results aren’t immediate: It can take months to determine the exact balance of DBS stimulation and medications to optimally control symptoms. While certain symptoms may subside almost immediately, it may take a long amount of time to find the right combination for long-term effects.
Although deep brain stimulation is generally considered to be low risk, any type of surgery has the risk of complications. Also, the brain stimulation itself can cause side effects.
Surgery risks
Deep brain stimulation involves creating small holes in the skull to implant the electrodes into the brain tissue as well as performing surgery to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:
- Misplacement of leads
- Bleeding in the brain
- Stroke
- Infection
- Breathing problems
- Nausea
- Heart problems
- Seizure
Possible side effects after surgery
Side effects associated with deep brain stimulation may include:
- Seizure
- Infection
- Headache
- Confusion
- Difficulty concentrating
- Stroke
- Hardware complications, such as an eroded lead wire
- Temporary pain and swelling at the implantation site
A few weeks after the surgery, the device will be turned on and the process of finding the best settings for you begins. Some settings may cause side effects, but these often improve with further adjustments of your device.
Because there have been infrequent reports that the DBS therapy affects the movements needed for swimming, the Food and Drug Administration recommends consulting with your doctor and taking water safety precautions before swimming.
Possible side effects of stimulation
- Numbness or tingling sensations
- Muscle tightness of the face or arm
- Speech problems
- Balance problems
- Lightheadedness
- Vision problems, such as double vision
- Unwanted mood changes, such as anger and depression
Some possible positive Effects
- Symptom reduction: DBS often reduces symptoms significantly. These include motor symptoms like stiffness, tremor, slowness and dyskinesia. DBS has also been shown to aid in on/off fluctuations, improve mood and quality of life, and increase overall energy level.
- Little to no damage: In contrast to previous methods, DBS does not damage portions of the brain, nor remove nerve cells.
- Decreased medication needs: Utilizing DBS in addition to levodopa could decrease a person’s need for medication, thus, decreasing medication access and cost issues, as well as levodopa side effects.
- Individualized treatment: Electrodes and stimulation frequency and intensity can be controlled by physicians and the individual with DBS, and can be subjectively altered when needed.
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