Deep Brain Stimulation: Causes, Symptoms, Diagnosis, Treatment, and Prevention
In deep brain stimulation (DBS), electrodes are implanted in specific parts of the brain to control abnormal brain activity or chemical imbalances that can cause a variety of medical conditions. By placing a device under the chest skin and connecting them to the electrodes by a wire, DBS can be adjusted to deliver varying amounts of electrical impulses based on the patient's needs.
Causes of Deep Brain Stimulation
DBS is used to treat patients who have movement disorders or psychiatric conditions that are not well controlled by medications or other therapies. Some of the conditions that can be treated by DBS are:
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Parkinson’s disease: a progressive neurological disorder that affects movement, causing tremors, stiffness, slowness, and balance problems.
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Essential tremor: a common movement disorder that causes involuntary shaking of the hands, head, voice, or other body parts, especially during voluntary actions such as writing or drinking.
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Dystonia: a movement disorder that causes involuntary muscle contractions, resulting in abnormal postures or movements of the body or limbs.
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Epilepsy: a neurological disorder that causes recurrent seizures, which are sudden bursts of abnormal electrical activity in the brain that affect consciousness, behavior, or sensation.
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Obsessive-compulsive disorder (OCD): a psychiatric disorder that causes persistent and intrusive thoughts, urges, or images (obsessions) that are followed by repetitive behaviors or mental acts (compulsions) that are performed to reduce anxiety or distress.
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Depression: a psychiatric disorder that causes persistent and pervasive low mood, loss of interest, and reduced ability to function in daily life.
The exact causes of these conditions are not fully understood, but they are thought to involve abnormalities or imbalances in the brain circuits or chemicals that regulate movement, mood, or cognition.
Symptoms of Deep Brain Stimulation
The symptoms of the conditions that can be treated by DBS vary depending on the type and severity of the disorder. Some of the common symptoms are:
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Tremor: involuntary shaking of a body part, usually the hands, arms, legs, or head.
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Bradykinesia: slowness of movement or difficulty initiating movement.
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Rigidity: stiffness or resistance to movement of the muscles or joints.
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Dyskinesia: involuntary or abnormal movements, such as twisting, jerking, or writhing.
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Gait problems: difficulty walking, maintaining balance, or turning.
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Speech problems: difficulty speaking, swallowing, or controlling the volume or tone of the voice.
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Cognitive problems: difficulty with memory, attention, planning, or problem-solving.
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Mood problems: feelings of sadness, hopelessness, guilt, or worthlessness.
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Anxiety problems: feelings of nervousness, worry, fear, or panic.
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Obsessive-compulsive problems: recurrent and unwanted thoughts, impulses, or images that cause distress or anxiety, and repetitive behaviors or mental acts that are performed to neutralize or reduce the distress or anxiety.
Diagnosis of Deep Brain Stimulation
Based on the patient's medical history, physical examination, and neurological tests, DBS can be used to diagnose certain conditions. To rule out other causes of the symptoms or identify the target areas for DBS, imaging tests may also be performed, such as magnetic resonance imaging (MRI) or computed tomography (CT). Furthermore, psychological tests or evaluations may be required to assess the patient's mental health and cognitive abilities.
Treatment of Deep Brain Stimulation
When medications or other therapies fail to provide adequate symptom relief or improvement in quality of life, DBS is an alternative treatment option. A DBS procedure is not a cure for the underlying conditions, but it can help reduce the severity or frequency of symptoms and improve the patient's functionality and well-being.
The DBS procedure involves two main steps: the implantation of electrodes and the programming of the device. The electrode implantation is a surgical procedure that is performed under general anesthesia or local anesthesia with sedation. The surgeon makes small holes in the skull and inserts thin wires with electrodes at the tips into the target areas of the brain. They are then connected to a pulse generator which is implanted into the chest. Battery-powered pulse generators stimulate the brain by sending electrical impulses to electrodes.
A few weeks after the surgery, the device is programmed. The programming involves adjusting the settings of the device, such as the voltage, frequency, and duration of the electrical impulses, to achieve the optimal effect for the patient. In order to program the pulse generator, a neurologist or nurse uses a handheld device that communicates with it. To fine-tune the settings and monitor the patient's response, the programming may require several sessions and follow-up visits.
Prevention of Deep Brain Stimulation
There is no known way to prevent the conditions that can be treated by DBS, but some lifestyle factors may help reduce the risk or delay the progression of some of these conditions. These factors include:
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Eating a balanced and nutritious diet
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Exercising regularly and moderately
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Avoiding smoking and excessive alcohol consumption
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Managing stress and practicing relaxation techniques
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Seeking professional help for mental health problems
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Taking medications as prescribed and following the advice of the doctor
In patients with movement disorders or psychiatric conditions that cannot be controlled by medications or other therapies, DBS is a safe and effective treatment. It is possible that DBS will improve a patient's symptoms and quality of life, but it also comes with some risks and side effects. Multidisciplinary teams of specialists must evaluate and monitor DBS carefully, as it is not suitable for everyone. In addition to regular follow-up visits and the possibility of making adjustments to the device, DBS is not a cure for the underlying conditions, but a means of better managing them.
