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Deep Brain Stimulation: The Procedure
During an inpatient surgical procedure, the patient receives the implantation of the lead in targeted structures of the left or right side of the brain. The patient is discharged home the next day. Approximately three days after discharge, the patient returns for an outpatient surgical procedure to implant the neurostimulator. These two steps are repeated for the other brain hemisphere approximately three to four weeks later.
The patient typically participates in a medical rehabilitation program shortly after the final outpatient surgical procedure to optimize the benefit of DBS surgery. Upon completion of the final outpatient surgical procedure and during the rehabilitation stay, the patient’s neurostimulator is programmed. The neurostimulator will be adjusted as needed to get the best possible symptom control with minimal side effects.
DBS Components
Lead: The lead is a thin, insulated wire with four electrodes at the tip that is implanted in the brain.
Extension: The lead is connected to an extension, a thin, insulated coiled wire that is threaded under the skin from the head, down the neck, and into the upper chest.
Neurostimulator: The extension is connected to a neurostimulator, a small, sealed device similar to a cardiac pacemaker that contains a battery and electronics. The neurostimulator is implanted beneath the skin in the chest. It produces the electrical pulses needed for stimulation. These electrical pulses are delivered through the extension and through the lead to the appropriate target in the brain.
External components of the system include a clinician programmer for adjusting neurostimulator parameters, and the patient’s own programmer, called the Access Review Device, which turns the neurostimulator off or on.
What are the Benefits of the DBS Procedure?
DBS is reversible and non-destructive to brain tissue. Significant improvement is seen in tremor, stiffness, and slowness. There is also often a reduction in medication induced dyskinesia, motor fluctuations, gait disturbance, and balance problems. Medication "on time" typically increases up to 7 hours, and medication use may decrease by 50%.
Essential tremor patients typically experience a reduction in tremor of 80 to over 90%, often with subsequent discontinuation of medication. Patients with Dystonia also see significant improvement in involuntary muscle contraction, and ongoing post DBS follow-up continues to show promising results in this patient population.
What are the Risks of the DBS Procedure?
The DBS surgery carries the same risks associated with any other brain surgery, including but not limited to bleeding and infection. For a full accounting of both the major and minor possible adverse effects, a visit with the DBS physician team is recommended. In depth information concerning DBS risks and benefits can be found through links to the Medtronic website via the Northwest Hospital website at nwhospital.org.
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