Deep Brain Stimulation for Essential Tremor

Deep Brain Stimulation for Essential Tremor

How long does it take to recover from deep brain stimulation?

What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a neurosurgical procedure that involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or the electrical impulses can affect certain cells and chemicals within the brain.

Deep brain stimulation (DBS) is used to treat a number of movement disorders, including Essential Tremor. DBS is a way to stimulate the thalamus, a structure deep in the brain that coordinates and controls muscle activity. The true cause of essential tremor is still not understood, but it is thought that the abnormal brain activity that causes tremor is processed through the thalamus.

The deep brain stimulation system consists of four parts:

. Leads (thin insulated wires) that end in electrodes that are implanted in the brain.

. A small pacemaker-like device, called a pulse generator that creates the electrical pulses.

. Extension leads that carry electrical pulses from the device and are attached to the leads implanted in the brain.

. Hand-held programmer device that adjusts the device’s signals and can turn the device off and on.

 

 

Read more about : Deep Brain Stimulation Surgery

Read more about : Deep Brain Stimulation for Parkinson’s disease

 

 

Before Deep Brain Stimulation Surgery

Who is a candidate for deep brain stimulation surgery?

Before being considered a candidate for deep brain stimulation (DBS), patients must undergo an extensive evaluation process. Ideally, a multidisciplinary team of specialists including a neurologist, neurosurgeon, neuropsychologist and psychiatrist will assess the patient.

If patients are well managed on medications, DBS is not considered. Candidates for DBS are generally patients who meet these criteria:

. Symptoms are not well controlled despite receiving the appropriate dose of medications.

. Symptoms are significantly reducing a patient’s quality of life.

. Side effects from current medications cannot be tolerated.

 

 

Advantages

What are the advantages of deep brain stimulation (DBS)?

Deep brain stimulation (DBS) has many advantages:

. Unlike some other surgical options, DBS does not cause permanent damage in any part of the brain.

. The electrical stimulation is adjustable and reversible as the person's disease changes or his or her response to medications change.

. Because DBS is reversible and causes no permanent brain damage, use of innovative not-yet-available treatment options may be possible.

. The stimulator can also be turned off at any time if DBS is causing excessive side effects without any long-term consequences.

 

Risks and Complications

Although deep brain stimulation is minimally invasive and considered safe, any type of surgery has the risk of complications. Also, the brain stimulation itself can cause side effects.

Complications of DBS fall into three categories: surgery complications, hardware (device and wires) complications, and stimulation-related complications.

. Surgery risks

Deep brain stimulation involves creating small holes in the skull to implant the electrodes, and surgery to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:

. Misplacement of lead

. Bleeding in the brain

. Stroke

. Infection

. Breathing problems

. Nausea

. Heart problems

. Seizure

. Possible side effects after surgery

Side effects associated with deep brain stimulation may include:

. Seizure

. Infection

. Headache

. Confusion

. Difficulty concentrating

. Stroke

. Temporary pain and swelling at the implantation site

A few weeks after the surgery, the device will be turned on and the process of finding the best settings for you begins. Some settings may cause side effects, but these often improve with further adjustments of your device.

Because there have been infrequent reports that the DBS therapy affects the movements needed for swimming, the Food and Drug Administration recommends consulting with your doctor and taking water safety precautions before swimming.

. Possible side effects of stimulation

. Numbness or tingling sensations

. Muscle tightness of the face or arm

. Speech problems

. Balance problems

. Lightheadedness

. Vision problems, such as double vision

. Unwanted mood changes, such as anger and depression

. Hardware complications

Hardware complications include movement of the leads, lead failure, failure of any part of the DBS system, pain over the pulse generator device, battery failure, infection around the device and the device breaking through the skin as the thickness of skin and fat layer change as one ages.

How you prepare

. First, weigh the pros and cons

Deep brain stimulation is a serious and potentially risky procedure. Even if you might be eligible for deep brain stimulation, you and your doctors must carefully weigh the risks and potential benefits of the procedure.

. Next, preparing for surgery

Before surgery, you'll need medical tests to make sure that deep brain stimulation is a safe and appropriate option for you. You'll also need brain-imaging studies, such as an MRI, before the surgery, to map the areas of your brain to implant the electrodes.

During Deep Brain Stimulation Surgery

How does Deep Brain Stimulation work?

To treat essential tremor with deep brain stimulation, electrodes are placed in the thalamus during surgery. The electrodes are connected by wires to a type of pacemaker device (called an impulse generator, or IPG) implanted under the skin of the chest, below the collarbone. Once activated, the device sends continuous (painless) electrical pulses to the thalamus, blocking the impulses that cause tremors. This has the same effect as thalamotomy without actually destroying parts of the brain.

The IPG can easily be programmed using a computer that sends radio signals to the IPG. Patients are given special magnets so they can externally turn the IPG on or off.

Depending on use, the stimulators may last three to five years. The IPG replacement procedure is relatively simple.

 

After Deep Brain Stimulation Surgery

How effective is Deep Brain Stimulation?

Deep brain stimulation provides moderate relief for approximately 90% of patients with essential tremor.

After the procedure

The average hospital stay following implantation of the DBS leads is 1 to 2 days. Most patients are able to return home on the same day that their battery is placed.

A few weeks after surgery, the pulse generator in your chest is activated in your doctor's office. The doctor can easily program your pulse generator from outside your body using a special remote control. The amount of stimulation is customized to your condition, and may take as long as four to six months to find the optimal setting.

Stimulation may be constant, 24 hours a day, or your doctor may advise you to turn your pulse generator off at night and back on in the morning, depending on your condition. You can turn stimulation on and off with a special remote control that you'll take home with you. In some cases, your doctor may program the pulse generator to let you make minor adjustments at home.

The battery life of your generator varies with usage and settings. When the battery needs to be replaced, your surgeon will replace the generator during an outpatient procedure.

Recovery

. Your stitches or staples will be removed 10 to 14 days after surgery.

. Each of the 4 pin sites should be kept covered with band aids until they are dry. These should be changed every day as necessary.

. You will be able to wash your head with a damp cloth, avoiding the surgical area.

. You may only shampoo your hair the day after your stitches or staples are removed, but only very gently.

. You should not scratch or irritate the wound areas.

. You should not engage in light activities for 2 weeks after surgery. This includes housework and sexual activity.

. You should not engage in heavy activities for 4 to 6 weeks after surgery. This includes jogging, swimming, or any physical education classes. Anything strenuous should be avoided to allow your surgical wound to heal properly. If you have any questions about activities, call your doctor before performing them.

. You should not lift more than 5 lbs. for at least 2 weeks.

. You should not raise your arms above your shoulders or over bend or stretch your neck.

. Depending on the type of work you do, you may return to work within 4 to 6 weeks.

When would I need to call my doctor?

Call your doctor immediately if you experience any of the following symptoms:

. Severe and persistent headaches.

. Bleeding from your incision.

. Redness or increased swelling in the area of the incision.

. Loss of vision.

. A sudden change in vision.

. A persistent temperature of 101 degrees Fahrenheit or higher.

How long does the battery in the impulse generator device last?

Batteries can last 3 to 5 years in non-rechargeable devices and up to 9 years in rechargeable battery devices. However, these times may vary significantly. A simple outpatient procedure is needed to replace the battery. Rechargeable battery devices can be charged daily (for about 30 minutes) or every 10 to 14 days (for about 4 hours). Your doctor will discuss how often you should recharge your battery based on your therapy settings.

Deep Brain Stimulation Surgery Cost

The cost of Deep Brain Stimulation Surgery in Iran is $ 9000.

 

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