Deep Brain Stimulation - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x Deep brain stimulation (DBS) is a neurosurgical technique used in the treatment of movement and psychiatric disorders. A battery-operated neurostimulator sends impulses to electrodes which have been implanted in the brain, however the precise mechanism by which DBS alters brain activity remains not fully understood. Until the development of DBS in the 1980s, neurosurgeons only had ablative techniques to treat such movement disorders, psychiatric disorders, and epilepsy. Rather than creating lesions in functional targets, such as ablation the subthalamic nucleus in the case of Parkinson’s disease, DBS achieves a similar effect via electrical stimulation, however is reversible and adjustable. DBS is a minimally-invasive and stereotactic procedure with or without real-time image-guided navigation as an adjunct. By Dr. Craig Hacking, A. Prof Frank Gaillard [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons Figure 1A sagittal radiograph of a skull with DBS probes in-situ Indications Deep brain stimulation can be used to treat a range of movement disorders refractory to (or complicated by) pharmacological therapy. Conditions that have been trialled for treatment via DBS include Parkinson’s disease, dystonia, treatment-resistant depression, and obsessive-compulsive disorder (OCD). Procedure DBS can be performed under local or general anaesthestia. A rigid frame is used to fix the skull and a scan is obtained, and the surgical anatomical target is identified and co-ordinated. A burr hole is created in the cranium over the frontal bone. An electrode is advanced to the target, along a trajectory guided by the frame. Leads can be placed uni- or bi-laterally. The leads are secured to the cranium and a wire is tunnelled under the scalp and down to the pacemaker (Fig. 2). This can be secured, typically to the fascia overlying pectoralis major (similar to a cardiac pacemaker). The neurostimulator can be switched on and off via an external device, and can be programmed to the settings which achieve optimal symptomatic control. By Shamir R, Noecker A and McIntyre C [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons Figure 2The typical positioning of DBS electrodes and connection to the pacemaker Complications Specific complications can be divided into operation-related, hardware-related, and stimulation-related. Operation-related complications include peri-operative intracranial haemorrhage and electrode malposition Hardware-related complications include electrode migration, electrode fracture, and infection and erosion Stimulation-related complications include sensorimotor conditions including dyskinesia and blepharospasm, transient confusion, mood changes, or even psychiatric conditions, such as manic episodes Key Points Deep brain stimulation is minimally invasive, reversible, and adjustable DBS can be used for a range of refractory movement disorders, and there is increasing evidence that it is efficacious in some psychiatric disorders Potential complications include intracerebral haemorrhage and hardware malfunction Frequent questions What is deep brain stimulation (DBS)? Deep brain stimulation (DBS) is a neurosurgical procedure that involves implanting electrodes in the brain to deliver electrical impulses, thereby treating various movement and psychiatric disorders. Unlike traditional ablative techniques, DBS is reversible and allows for adjustable stimulation. What conditions can deep brain stimulation treat? DBS is effective for a range of movement disorders, particularly those resistant to medication, including Parkinson's disease, dystonia, and also psychiatric conditions like treatment-resistant depression and obsessive-compulsive disorder (OCD). How is the DBS procedure performed? The DBS procedure can be conducted under local or general anaesthesia, involving the use of a rigid frame to stabilise the skull, creating a burr hole, and advancing an electrode to a targeted brain area. The leads are then secured, and a neurostimulator is implanted to manage stimulation settings. What are the potential complications of deep brain stimulation? Complications from DBS can be classified into operation-related issues, such as intracranial haemorrhage, hardware-related problems like electrode migration, and stimulation-related effects, which may include dyskinesia and mood changes. Why is deep brain stimulation considered a significant advancement in neurosurgery? DBS represents a notable advancement because it provides a minimally invasive, reversible, and adjustable treatment option for refractory movement and psychiatric disorders, offering a less destructive alternative to traditional surgical methods. Rate This Article