Deep Brain Stimulation (DBS) is a serious invasive procedure. According to Sorar et al. (2018) “As in all surgical operations, this procedure is not without complications and problems.”i The Sorar paper is based on six years of following 181 patients who were treated with DBS for either Parkinson’s disease (159 patients), a condition of involuntary muscle contractions called dystonia (13 patients) or essential tremor (9 patients). In addition, DBS is now also being used to treat certain cases of epilepsy, chronic pain, Tourette’s syndrome and obsessive-compulsive disorder. It is in clinical trials for other psychiatric conditions and movement disorders.
How does DBS work?
The image-guided DBS surgery has two components to it:
- Drilling a hole in the skull in order to place electrodes directly into the targeted brain area, and
- Surgically implanting a “battery pack” in the chest area and connecting the electrodes using wires under the skin in order to power the electrical stimulation.
During the surgery, the electrodes are stimulated as a test to ensure that the proper area was targeted to produce the desired effect (stop tremors; relax contracted muscles) without undesirable side effects. Once this is evident, the electrodes are connected to the implanted battery pack (the power will be activated a few weeks later) and the patient is hospitalized overnight for observation.
DBS works by regulating brain messaging systems. Brain cells communicate with each other by electrical signaling patterns. When these patterns become abnormal, DBS basically interrupts the atypical signaling patterns in a way that allows the cells to communicate more smoothly and thereby lessens symptoms.ii However, DBS does not correct or cure the underlying condition, and it is generally recommended only if medication does not ease symptoms and the patient is a candidate for the procedure.
DBS can have a wide range of complications and side effects. Some of them, such as migration of an electrode or an infection around an implant, are related to the hardware itself. However, more commonly there are side effects—usually temporary—that include tingling in the face or limbs, slight paralysis, speech or vision problems, confusion or having a hard time concentrating, sensations of dizziness or balance problems, seizures, and slight paralysis. DBS surgery comes with a slightly increased risk of bleeding in the brain, which may lead to a stroke or other neurological symptoms.
The importance of experience
DBS has been in use for about 20 years. The Sorar paper makes an important point: the more experienced the neurosurgical team, the lower the risks of complications and side effects. The authors write, “Advances in our understanding, related technology, and surgical techniques have led to a dramatic decrease in the rates of these adverse events in the past two decades. Our study affirms the role of cumulative experience at individual centers in reducing the rate of complications.” They make the point that patients should be well-informed about the potential problems during and after surgery.
An alternative to DBS for essential tremor
In the Sorar study, the large majority of patients were treated for Parkinson’s disease (PD), and only 9 out of 181 patients were treated for essential tremor (ET). Ironically, there are far more individuals with ET than PD, and ET medications are less reliable for symptom control than the current medications for PD. Even when medication reduces ET symptoms, eventually greater doses may be required as ET advances – or cause such undesirable side effects that the person stops using them.
Sperling Neurosurgery Associates provides MRI-guided Focused Ultrasound (MRgFUS) to control hand tremors from ET. MRgFUS is a noninvasive, outpatient alternative to DBS. MRgFUS is an outpatient procedure that is safe, effective and durable, with minimal-to-no side effect risks.
For more information or a consultation, contact Sperling Neurosurgery Associates.
iSorar M, Hanalioglu S, Kocer B, Eser M et al. Experience Reduces Surgical and Hardware-Related Complications of Deep Brain Stimulation Surgery: A Single-Center Study of 181 Patients Operated in Six Years. Parkinsons Dis. 2018 Jul 22;2018:3056018.