Deep Brain Stimulation: What is it, Risks, and Who gets it

What is deep brain stimulation and what are its uses?

Deep brain stimulation (DBS) is a surgical procedure that involves implanting a device, similar to a pacemaker, into the brain. This device delivers electrical stimulation to specific areas of the brain. DBS is primarily used to treat certain movement disorders, such as Parkinson’s disease, essential tremor, and dystonia, when medications have not provided adequate relief.

The procedure involves placing thin electrodes into the brain in targeted areas. These electrodes are connected by wires to a stimulator device, which is usually implanted under the skin near the collarbone. The stimulator sends electrical pulses to the brain, modulating the abnormal nerve signals that cause movement disorders.

DBS is also being studied for use in treating other conditions, such as epilepsy, obsessive-compulsive disorder (OCD), and depression, although these uses are still considered experimental and are not as widely accepted as for movement disorders.

What are the risks of deep brain stimulation?

Deep brain stimulation (DBS) is generally considered safe, but like any surgical procedure, it carries some risks. These can include:

1. Surgery risks: As with any surgery, there are risks such as infection, bleeding, and adverse reactions to anesthesia.
2. Brain hemorrhage: There is a small risk of bleeding in the brain during or after the surgery.
3. Stroke: In rare cases, the surgery can cause a stroke, which can lead to neurological deficits.
4. Seizures: Some people may experience seizures after the procedure, especially if they have a history of epilepsy.
5. Cognitive changes: There is a risk of changes in cognitive function, including memory, speech, and mood changes.
6. Hardware complications: The implanted device may malfunction or become displaced, requiring additional surgery to correct.
7. Infection: There is a risk of infection at the site of the surgery or where the device is implanted.
8. Electrode misplacement: In some cases, the electrode may not be placed in the intended location, affecting the effectiveness of the treatment.

It’s important for individuals considering DBS to discuss these risks with their healthcare team to determine if the potential benefits outweigh the risks for their specific condition.

Who is a good candidate for deep brain stimulation, and who is not?

Deep brain stimulation (DBS) is typically considered for individuals with certain movement disorders, particularly Parkinson’s disease, essential tremor, and dystonia, when medications have not provided adequate symptom control or have caused significant side effects.

Good candidates for DBS generally meet the following criteria:

1. Diagnosis: They have a confirmed diagnosis of Parkinson’s disease, essential tremor, or dystonia.
2. Symptoms: They have significant motor symptoms (such as tremors, rigidity, or involuntary movements) that are not well controlled with medications.
3. Overall health: They are in good overall health and able to tolerate surgery and the ongoing management of the device.
4. Expectations: They have realistic expectations about the outcomes of DBS and are willing to participate in postoperative care and follow-up.

On the other hand, DBS may not be suitable for individuals who:

1. Have unstable or poorly controlled medical conditions: Conditions such as heart disease, uncontrolled diabetes, or active cancer may increase the risks associated with surgery.
2. Have significant cognitive impairment: DBS can sometimes lead to cognitive changes, so individuals with significant cognitive impairment may not be suitable candidates.
3. Have unrealistic expectations: It’s important for candidates to have a realistic understanding of the potential benefits and limitations of DBS.
4. Are unable to undergo surgery: Some individuals may not be suitable for surgery due to factors such as age, overall health, or other medical conditions.

Ultimately, the decision about whether someone is a good candidate for DBS is made on a case-by-case basis by a multidisciplinary team that includes neurologists, neurosurgeons, and other healthcare professionals.