Deep Brain Stimulation

Deep brain stimulation (DBS) is a procedure that involves delivering a mild electrical current to a specific part of the brain via an implanted device. The electrical current stimulates the cells in the targeted area of the brain, improving the way it works.

The electrical current reaches the brain via wires that are attached to a device, which is implanted under the skin near the collarbone.

Cleveland Clinic Abu Dhabi was the first center in the UAE to perform DBS and has since performed the highest number of DBS surgeries in the UAE.

How does deep brain stimulation work?

Our neurons are an important type of brain cell, and we have billions of them within our brain. They are nerve cells that send messages all over the body, using electrical and chemical signals, and control many things, such as breathing, talking, walking, and thinking. If our neurons aren’t working properly, it affects the abilities that they control. If the neurons are severely impaired, the abilities can be lost completely.

Certain brain conditions make neurons less active, in different parts of the brain. Depending on the area affected, this can disrupt the abilities which are controlled by that particular area.

DBS delivers an artificial electric current to the affected area of the brain which makes the neurons more active. This can help with the symptoms of certain brain conditions.

When is deep brain stimulation used?

DBS is used to treat Parkinson’s disease, and other conditions that affect your brain, such as epilepsy, as well as movement disorders and mental health conditions.

At Cleveland Clinic Abu Dhabi, DBS used is to treat the following conditions which haven’t responded to medication:

• Dystonia
• Essential tremor
• Epilepsy
• Parkinson’s disease
• Obsessive-compulsive disorder.

What happens before a deep brain stimulation procedure?

As with any procedure, your doctor will first discuss the advantages, disadvantages and risk of DBS. A number of screening tests may be performed to ensure suitability.

You will also be asked about any medication you are taking and given instructions on how to prepare your skin for the procedure. You will need to fast for 8 hours before the procedure (no liquids 2 hours before) as the procedure involves general anesthesia.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans of the brain will provide detailed images so your doctor can decide the best location for the wires to be implanted.

What happens during a deep brain stimulation procedure?

DBS requires more than one procedure. In the first procedure, the leads are placed into the brain. Under sedation, a CT scanner takes images and helps the doctor identify the route for electrode placement. Once identified, local anesthesia is given, and a small incision is made. A surgical drill makes a small opening in the skull and the leads are put in place by a neurosurgeon. You will be asked questions during the placement so that the neurosurgeon can ensure they are in the right place.

The placement of the leads and the number used will depend on the condition being treated. Once secure, the electrode end is protected and tunneled to the back of the head, under the skin, and the incisions are closed.

Another CT scan is performed to confirm placement of the electrodes. Once you have recovered, you will be sent home.

The second procedure involves implanting the pulse generator under general anesthesia. An incision is made just under the collarbone and a small pouch-like space is created which holds the pulse generator in place. An extension wire is then inserted which travels between the outside of the skull and underside of the skin under the collarbone.

The extension wires are then connected at one end to the DBS electrodes and to the pulse generator at the other. This is placed in the pouch and sewn shut. Once you have recovered, you will be sent home.

What happens after deep brain stimulation?

Within a few weeks of the procedure, you will have a follow-up appointment where the pulse generator will be programmed. The setting may be adjusted over time so your medical team can find what works best for you.

What are the advantages of deep brain stimulation?

DBS offers a treatment option to patients when medications haven’t worked or are no longer effective. Conditions such as Parkinson’s disease can severely impact daily life, and DBS can offer life-changing results.

The procedure can be adjustable, with the pulse generator settings being fine-tuned until they work for you. It is also reversible, as the leads and generator can be removed if it doesn’t work or causes side effects.

 

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