What are the benefits of deep brain stimulation?
The aims of DBS depend upon the medicial condition being treated. Our goals may include:
- to relieve or reduce tremor
- medication reduction
- improvement in rigidity (stiffness) or bradykinesia (slowness) in Parkinson’s
- improvement in other abnormal movements
- improved daily function
- improved quality of life
How is deep brain stimulation performed?
The first operation (Stage 1) involves placement of special wires (electrodes) in specific regions of the brain. Before surgery you will have a special frame attached to your head. This is usually done with local anaesthetic and is not too bothersome. Then you will have a CT scan before being taken to the operating theatre. Some more local anaesthetic and some light sedation will be given before one or two small holes are shaved in your skull. This does not hurt, and is usually much less uncomfortable than going to the dentist!
The electrode is then slowly inserted and the electrical activity will be monitored to guide its final placement. Once we are confident that we are in the correct position, we will stimulate through the tip of the electrode to see whether this helps and too look for side effects. We then secure the electrode in place. A CT brain is performed immediately after surgery to confirm satisfactory electrode placement.
The second operation (Stage 2) involves giving you a general anaesthetic and running the wires under your skin from your head to your chest. They are connected to a battery placed under the skin just below your collarbone (sometimes this is placed in your abdomen or flank). You will be discharged from hospital one or two days later. Your neurologist will adjust your stimulation settings and medications progressively over a number of months.
What are the risks of surgery?
There is a very small risk of infection, haemorrhage (bleeding), stroke, and seizures (epilepsy). The risk that the surgery could cause death is extremely small (less than 1 in 100). Over 95% of patients come through surgery without significant complications.
What are the benefits of surgery?
In well-selected patients, where the diagnosis is clear and the symptoms they have are regarded as likely to respond to surgery, the benefits are generally quite good.
Patients having surgery for Parkinson’s diease typically see a reduction in medication requirements; improved tremor, bradykinesia and rigidity; reduced dyskinesias and motor fluctuations; shorter and less severe “off periods”.
Patients having surgery for tremor usually experience a fairly substantial reduction in tremor, sometimes with near complete abolition of their tremor.
Tourette’s patients also tend to do well, with around two-thirds or more experiencing a major improvement in their motor and vocal tics, as well as their level of disability.
How long will the benefits last?
Surgery for Essential Tremor usually reduces the severity of the tremor. Over two-thirds of Essential Tremor patients will experience complete or near complete tremor resolution at up to 8 years following surgery.
In Parkinson’s disease, the underlying condition (a neurodegenerative condition) does deteriorate with time, however even after 5-10 years most patients continue to experience a significant benefit from deep brain stimulation.
What happens when you go home?
It’s important that you take it easy for 6 weeks and that you try to do an hour of gentle exercise such as walking every one to two days.
Four days after your discharge from hospital, your GP should check your wounds. It is recommended that you do not sign or witness any legal documents until your visit to your GP.
After surgery, you will be given instructions about when the staples need to be removed. This can be done by either your GP or by the Precision Clinical Coordinator.
After several weeks you will be reviewed by your neurologist and neurosurgeon. You should not drive a motor vehicle or operate heavy machinery until they give you the all clear.
If you have had deep brain stimulation you will also be given information about things you need to avoid, including metal detectors at airports. It is very important that you read this information carefully.
What should you notify your doctor of after surgery?
- Increasing headache
- Swelling or infection of the wounds
- Leakage of fluid from the wound
- Fitting (seizures)
- Abnormal sensations or movements in your face, arms or legs
- Weakness or numbness
- Any other concerns