- Deep Brain Stimulation (DBS) involves implantation in the brain of a pulse generator that can be adjusted by telemetry and can be activated and deactivated by clinicians and patients.
- A typical DBS system has three components: a pulse generator, which is implanted in the sub-clavicular area; one or two leads, which are inserted into the target area in the brain; and an insulated extension wire passed subcutaneously that connects the generator with the lead. The system generates short electrical pulses, similar to a cardiac pacemaker, that suppress brain activity.
- DBS is approved by the US FDA for Parkinson’s disease, severe essential tremor, primary dystonia and intractable obsessive-compulsive disorder. For each of these conditions, DBS is considered only when nonsurgical management has failed.
- Before DBS became available, the only surgical options for patients with advanced Parkinson’s disease, tremor, or dystonia were ablative procedures such as pallidotomy (ablation of part of the globus pallidus) and thalamotomy (ablation of part of the thalamus).
- Although pallidotomy and thalamotomy can have excellent results they are not as safe as DBS which has the advantage of being reversible, modulating the function of an area rather than destroying it. In addition, DBS is adjustable, and the settings can be optimized as the disease progresses over the years.
- DBS has the disadvantage of higher cost & of requiring lifelong maintenance of the hardware, for which the patient remains dependent on a medical center.
- In Parkinsonism, DBS is indicated only if patient is levodopa-responsive but is suffering from partial response or toxicity (dyskinesias) or on-off phenomena. In Parkinsonism, appendicular symptoms such as limb tremor and rigidity are more responsive to DBS than axial symptoms such as gait and balance problems.
- In Mumbai, DBS is done at many centres including Jaslok (Dr Paresh Doshi) and Hinduja(Dr Milind Sankhe). The cost (using rechargeable pulse generators that last up to 9 yrs) is about Rs. Ten Lakhs.