Deep Brain Stimulation

1. Physical examination: The doctor evaluates the symptoms of the patient. Patient’s having tremors or Parkinson’s disease may undergo testing of the motor symptoms with and without medications to assess the disease severity.

2. Blood and urine tests: These tests help in the identification of toxins and abnormalities.

3. CT scans and MRI scans: These imaging tests help the doctor in targeting the right area of the brain for symptomatic relief.

4. Electroencephalography: It is a test to determine the electrical activity of the brain. It is generally performed in epilepsy patients.

5. Neuro-psychological evaluation: It is a test done to measure how well a person’s brain is working.

6. Yale-Brown Obsessive Compulsive scale (YBOCs) testing: A rating scale is used to test the severity of an obsessive-compulsive disorder in a person.
   

The procedure is performed in two steps:
1. Brain surgery:
The patient is fitted into a special head frame to keep his/her head still during the surgery. This is known as a stereotactic head frame.
A brain MRI or CT scan is used to map the brain and identify the area in the brain where electrodes will be placed.
A local anesthesia is given before the surgery to numb the scalp area.
The electrodes are usually placed when the patient is awake and alert so that the stimulation effects can be fully tested. The brain has no pain receptors and therefore, does not need any anesthesia.
Sometimes the procedure may be performed under general anesthesia, where the patient is made unconscious before the procedure.
A thin wire lead with a number of contacts (electrodes) at the tips is implanted by the surgeon into a particular area of the brain, or one lead is implanted into each side of the brain.
A wire runs under the skin to a pulse generator or neurostimulator that is implanted near the collarbone.
The brain is carefully monitored during the procedure to ensure the proper placement of the electrode.

2. Chest wall surgery:
The second part of the procedure involves the implantation of the part of the device containing the batteries, that is, the pulse generator under the skin in the chest, near the collarbone.
This procedure is performed under general anesthesia.
The wires from the electrodes in the brain are placed under the skin and guided down to the pulse generator, which is battery-operated.
The generator is programmed in a way to send continuous electrical pulses to the brain.
The patient can control the generator and can turn it on or off by using a special remote control.

The complications associated with deep brain stimulation therapy are:

• Bleeding in the brain

• Misplaced leads

• Infection

• Stroke

• Nausea

• Difficulty in breathing

• Seizures

• Heart problems

• Headache 

• Confusion

• Difficulty in concentration

• Temporary swelling and pain at the site of implantation

• Hardware complications, line an eroded lead wire

• Tingling sensations

• Numbness

• Speech problems

• Tightness of the muscles in the face or arm

• Balance problems

• Lightheadedness

• Vision problems, like double vision

• Mood changes, like anger and depression
  

• The patient usually stays in the hospital for one or two days following deep brain stimulation therapy.
• The patient returns home on the day their battery is placed.
• The patient’s stitches will be removed 10 to 14 days after the procedure.
• The four-pin sites should be covered by band-aids till they are dry. These band-aids should be changed every day as required.
• The patient can wash his/her head using a damp cloth while avoiding the surgical area.
• The patient can shampoo his/her hair the day after stitches removal in a gentle manner.
• The patient is instructed to not irritate or scratch the wound area.
• The patient should avoid sexual activity for two weeks after the surgery.
• The patient should take complete rest for two weeks after the surgery.
• Heavy activities or physically strenuous activities should be avoided for four to six weeks after the surgery.
• Avoid heavy lifting for at least two weeks after the surgery.
• Avoid raising the arms above the shoulders, bending over, and stretching the neck.
• The patient can normally return to work four to six weeks after the procedure.

Contact the doctor as soon as possible if the following symptoms are seen:

1. Bleeding from the incision
2. Persistent, severe headaches
3. Loss of vision
4. Redness in the incision area
5. Increase in swelling in the incision area
6. Change in vision
7. High fever

A magnet will be provided to the patient to activate and deactivate the stimulator. This magnet should be kept at least one foot away from computer discs, credit cards, and televisions, as the magnet can damage these devices.
Screening devices and metal detectors can cause the neurotransmitter to switch on or off, leading to worsening of the symptoms. Therefore, the patient should always carry an identification card provided by the doctor, so that the patient may request assistance in bypassing these devices.
Home appliances like cell phones and computers usually do not interfere with the implanted stimulator.