Neurotechnology

Neurotechnology

Posted by Safe In4 Hub

What is deep brain stimulation surgery?

 


The conditions of deep brain stimulation are caused by irregular electrical activity in deep circuits of the brain. The procedure involves surgically implanting electrodes, or wires, in the brain that deliver electrical impulses to change this activity.

This system of electrical impulses has three parts, all of which are under the skin:

  1. The wires implanted in the brain (also called leads or electrodes)
  2. A battery pack that generates electrical impulses (also called a generator or IPG)
  3. Wires that connect the leads and the generator

The generator is carefully programmed for each patient to deliver electrical impulses to the right targets in their brain. The process is personalized for every patient's unique brain anatomy, individual symptoms and specific disease so that everyone achieves maximum results.


Deep brain stimulation is not a first-line therapy. That means before considering this surgery, patients must have tried medications and other therapies and not responded well.


Deep brain stimulation to treat the following:

  1. Idiopathic Parkinson's disease: Patients with atypical parkinsonism are not candidates
  2. Dystonia: Primary, generalized and segmental dystonias respond best
  3. Essential Tremor
  4. Chronic Pain
  5. Tourette's Syndrome
  6. Chronic Headaches: Cluster headaches, migraines, occipital neuralgia
  7. Obsessive Compulsive Disorder

Deep brain stimulation is an off-label procedure for Tourette's syndrome, cluster headaches and chronic pain. That means it is not yet an FDA-approved treatment for these conditions.

Deep brain stimulation may not be right for everyone. Multidisciplinary team considers the history, needs, and expectations of each patient before recommending surgery.

You may be a candidate for deep brain stimulation if:

  1. Your cognitive function is still intact. If it's not, the surgery can worsen cognitive decline.
  2. Your brain MRI that does not show signs of significant cerebrovascular disease or other neurodegenerative disease
  3. You are medically fit for 3-6 hours of awake surgery

During deep brain stimulation surgery

Patients are awake under light sedation during the deep brain stimulation surgery for two important reasons. It allows your neurosurgeon to monitor electrical activity in the brain during the procedure and to test to make sure the wires are in the right place.

Deep Brain Stimulation surgery is usually performed in two stages:

Stage 1: Your neurosurgeon makes a very precise roadmap of your brain with images obtained through an MRI or CT scan. A stereotactic frame - which keeps your head in a fixed position - is a three-dimensional guidance system that helps your surgeon pinpoint areas deep inside your brain. Once the target areas are located, your surgeon implants the wires, or electrodes, in your brain. Patients usually stay in the hospital for 1-2 days after this surgery.

Stage 2: Your neurosurgeon implants the battery pack and connecting wires in the chest 10 to 14 days after Stage 1. Patients are usually awake under general anesthesia and can go home the same day.

The generator that controls the electrical impulses in your brain is turned on two weeks after the implantation.

Some patients are concerned about being awake during surgery. If you are concerned, we invite you to speak to and connect with prior patients to learn more about the experience. The surgery can be done asleep using our advanced imaging capabilities for patients who do not want to be awake.



What to expect after deep brain stimulation
Patients considering deep brain stimulation should have realistic expectations for results. The surgery relieves symptoms, but it is not a cure. It can also take up to six months of adjustments after surgery for some patients to achieve optimal results.

  1. More than 70 percent of patients with Parkinson's Disease experience significant improvements to their motor function, or how they control their body movements. They may gain up to 4.5 hours of good "on time."
  2. Results can be dramatic in patients with dystonia. Some improvement occurs in 50 to 70 percent of patients.
  3. In patients with essential tremor, 72 to 85 percent of patients see improvement.

Risks of deep brain stimulation
Older patients, men and patients with high blood pressure are most at risk for:

  1. Bleeding: Symptomatic bleeding occurs in less than 2 percent of patients and may manifest as weakness, language difficulty, or confusion. Symptoms are permanent in less than 1 percent of all patients operated on.
  2. Infection: The implanted devices become infected in approximately 5 percent of patients, often requiring surgical removal.
  3. Seizures: Occurs in less than 1 percent of patients

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