Overview about Parkinson’s Disease:
Parkinson’s Disease is a long term neuro degenerative brain disorder. This disease progresses slowly in most of the people. Mostly the symptoms take years to develop, and people live for years with this Parkinson’s disease.
Generally a person’s brain slowly stops producing dopamine. Dopamine is a neuro transmitter which helps in handling the human movements and emotional responses.
Parkinson’s disease typically occurs in people over the age of 60, of which about one percent are affected. Males are more often affected than females.
Top 4 symptoms of Parkinson’s Disease:
- Slowness of movement
- Stiffness or rigidity of the legs, arms or trunk
- Balance troubles and possible falls (postural instability)
Deep Brain Stimulation (DBS):
Deep Brain Stimulation (DBS) is a surgical procedure, implanting a device which sends electrical signals to the brain cells which are responsible for the body movement. Electrodes are placed deep in the brain and are connected to a stimulator device, hence this procedure is named as Deep Brain Stimulation (DBS) Surgery. DBS surgery is similar to a cardiac pacemaker, a neuro stimulator uses electric pulses to regulate the brain activity. DBS surgery will help to reduce the symptoms of tremor, slowness of movement, stiffness and problems in walking caused by Parkinson’s Disease. Successful DBS surgery allows people to better manage their symptoms, reduce their medications and improve their quality of life compared to a regular lifestyle of a Parkinson’s effected person.
What is Deep Brain Stimulation?
In Deep Brain Stimulation surgery the electrodes are placed in a specific area of the brain (generally the subthalamic nucleus) depending on the symptoms being treated. The two electrodes should be placed on both the sides of the brain through small holes made at the top of the skull. The electrodes placed in the deep brain are connected by long extension wires which are passed under the skin and down the neck to a stimulator placed in chest part of the body. When the battery is turned on, the stimulator sends electrical pulses to block the faulty nerve signals causing tremors, rigidity, and other Parkinson’s symptoms.
Deep Brain Stimulator System:
A Deep Brain Stimulator System consists of three parts which are implanted inside the human body:
- Neuro stimulator – a pacemaker device which is operated through a battery and is self programmable that creates electric pulses. This device is placed in the chest part of the human body below the collarbone or sometimes in the abdomen.
- Lead – a coated wire and tipped with a number of electrodes that deliver electric pulses to the brain tissues / cells. It is placed deep inside the brain and connects to an extension cable wire through a small hole on the skull.
- Extension Wire – It is an insulated wire that connects the lead to the neuro stimulator. It is usually placed under the skin and leads from scalp, behind the ear, down the neck and till the chest room.
Every DBS patient will be provided with a handheld remote controller to turn the DBS system on and off. The doctor programs the deep brain stimulator system settings using a wireless device. The stimulation settings can be adjusted and altered as a patient’s condition changes over time. Typically, DBS surgery will help make the patients’ symptoms less severe so that lower medication doses may be used.
Who performs the DBS Surgery?
Deep Brain Stimulation Surgery is performed by neurosurgeon who has specialized training in functional neurosurgery. The surgical team also includes a neurologist.
Few days before DBS surgery:
Patient will typically undergo medical investigations (e.g., blood tests, electrocardiogram – ECG, Chest X-ray) few days before the DBS surgery. An MRI scan of the brain will be performed before the DBS surgery. Generally patient / attendant will sign consent forms and complete paperwork to inform the surgeon about the medical history and previous surgeries.
Stop taking all non-steroidal anti-inflammatory medicines 1 week before surgery, seek advice from your doctor before stoping. Stop smoking, chewing tobacco and drinking alcohol at least 1 week before and 2 weeks after the surgery because these activities can cause bleeding issues. Getting a surgical clearance from a physician or a cardiologist if you have a history of other medical or heart conditions is better. No food or drink, including the Parkinson’s medication is permitted after midnight on the night before the surgery.
Living with a Deep Brain Stimulator:
Once the DBS surgery has been programmed, patient will be discharged and sent to home with instructions for adjusting stimulator settings. The emote controller allows you turn the stimulator on and off, select predefined programs and adjust the strength of the stimulation. Most patients keep their DBS system turned on 24 hours day and night. Some patients with essential tremor will use in the day and turn the system off during nights. Doctor may alter the settings in the follow-up visits if required.
If the DBS system has a rechargeable battery, charging unit is required to charge the battery. On an average charging time is 1 to 2 hours per week (Doctor will let you know the instructions during discharge). You will have a choice of either a primary cell battery or a rechargeable unit and you need to discuss this with your surgeon prior to the DBS surgery.
Just like a cardiac pacemaker other devices such as cellular phones, pagers, microwaves, security doors and anti theft sensors will not affect the Deep Brain Stimulator. Ensure you carry with you the Implanted Device Identification card when flying, since the device will be detected at airport security gates.