Deep brain stimulation is a surgical treatment aimed at reducing the symptoms and characteristics of debilitating motor disorders, such as Parkinson's, dystonia, and essential tremor disease's. The procedure is also used to treat epilepsy, chronic pain, and obsessive-compulsive disorders. 

What is deep brain stimulation?

The treatment consists of surgical implantation of leads in the areas of the brain deputed to the control of movements, in addition with a medical device similar to that of a pacemaker, placed near the collarbone or in the abdominal region. This sends electrical impulses to the electrodes located in an area of the brain, blocking the signals that cause disabling motor symptoms. This device can also be controlled wirelessly via an external program that allows us to adjust the parameters of stimulation and even turn of the device if necessary. Patients will be able to have improvements in their clinical documentation.

Is the treatment painful or dangerous?

Deep brain stimulation is an invasive surgical intervention, in fact using a drill we make an incursion to the skull, the whole procedure is under local anaesthesia. Electrodes are then inserted deep into the brain to identify via clinical tests and neurophysiological examinations (the patient is asked to open and close their hand for example), through this we discover the area to post the final electrode catheter. This method has been used to treat Parkinson's disease for over 20 years, and the collected data has shown that this treatment provides positive results, in some cases where the patient is selected carefully there have been excellent positive results. 

Which patients can undergo the treatment?

The treatment is indicated for patients with Parkinson's, fluctuating motor disease, and dyskinesias, which can no longer be controlled by medication. The subjects who can undergo this treatment constitute 10% of the population suffering from Parkinson's. Relatively young and healthy subjects (age limit of 70 years) who present severe side effects from the drug therapy used to control the disease, must have a short positive duration response to the administration of levodopa. They require cognitive function, mental imaging, and normal intact neuroradiology. 

Follow up

After 2-3 weeks after surgery, when the clinical picture is sufficiently stable and has made an initial adjustment to the stimulator, the patient can be discharged. They will perform outpatient visits in the following months to make any changes to the parameters of stimulation and adjust drug therapy. 

The improvement of the symptoms of Parkinson's is evident in the first few days after the start of stimulation. This allows the reduction of the dose of dopaminergic drugs from 50 to 80%, with a percentage of about 15-20% of patients who do not need to assume the therapy.

 

Preparation standards

Before facing surgery the patient undergoes a thorough clinical examination with the use of the scale of assessment of the Parkinson's disease, to assess the patient according to their state of mind, daily living activities, motor functions, and complications due to therapy, progression and stage of the disease. Additionally, there is particular interest in the evaluation of the tremor, rigidity, akinesia and balance disorders. The analysis is performed both during the drug therapy and then after its withdrawal. Based on the evaluation and the prevalence of one of the symptoms on the other, a brain region is chosen where the implant lead will be placed. Dressing preimplantation during the surgery is aimed to further inspect the patient with: blood tests , chest X-ray , ECG, X-ray the skull, CT scan or MRI of the brain .