Photo: BETA Clinic

Source: BETA clinic in Bonn. The processes described relate to the processes in the Beta Clinic Bonn and may differ from the processes in other THS clinics.

Characteristic of the deep brain stimulation (DBS) is that areas of the brain are activated or deactivated with electrical impulses in order to treat certain diseases or symptoms. The deep brain stimulation belongs to functional neurosurgery, in which functions of the brain are influenced, but this influence can also be reversed, i.e. is reversible. In the operational Therapy For movement disorders, deep brain stimulation (DBS) has developed into an effective and recognized procedure, as documented by the large number of approximately 80.000 patients worldwide who have been helped with it. Deep brain stimulation can therefore be counted as one of the decisive therapeutic advances in the treatment of neurological diseases in recent decades.

What can deep brain stimulation (DBS) treat?

With deep brain stimulation, movement disorders can be treated that are caused by Parkinson's, essential tremor (ET) or dystonia and that cannot be adequately treated with other measures or that are already advanced. Serious psychiatric diseases are already being successfully treated with the deep brain stimulation method.

The current surgical targets for DBS are:

• the subthalamic nucleus (STN) - in Parkinson's disease
• the globus pallidus internus (GPi) - for dystonia
• the nucleus ventralis intermedius (VIM) - thalamus - for essential tremor (ET)

How does deep brain stimulation (DBS) work?

With deep brain stimulation, electrical stimulation probes are implanted in areas of the brain that have specific functions in the control circuit of body movements. These brain areas are stimulated with the help of the stimulation probes via high-frequency, pulsatile, monopolar or bipolar electrical impulses. This makes it possible to selectively switch areas of the brain on and off. In this way, disturbances can be switched on or off or reduced.

The special thing about it is that the function of the brain areas is preserved and the effect of the stimulation can be reversed at any time. Despite its clinical effectiveness, the exact mechanism of action of deep brain stimulation in the treatment of movement disorders is unknown.

What are the benefits of deep brain stimulation?

The main advantage over procedures in which brain tissue is / has been destroyed or removed (pallido or thalamotomy) lies in the possibility of adapting the stimulation depending on the effect achieved. DBS is a treatment method that can be reversed without the tissue having to be destroyed or removed on a large scale. The sometimes serious side effects of the drugs in Parkinson's disease, essential tremor (ET) or dystonia are not given in this form.

In contrast to many neurological clinical pictures, in which the rapidly progressing disease process forces the neurosurgeon to take an operative-therapeutic step, deep brain stimulation is an intervention that can be planned well in advance.

Deep brain stimulation (DBS) process

A few days before the operation

A few days before the operation, an MRI scan of the head and brain is performed. With the help of the MRI images, the procedure can be precisely planned and the entry and destination points as well as the three-dimensional access route can be determined. The operation can already be simulated in order to minimize the risk of the operation. Examinations in preparation for the operation and several discussions are also carried out, which precisely explain the course of the operation and also go into how long you have to be sober before the operation, whether and which medication you can take, etc.

The day of the operation

In order to be able to implant the electronic probes, a so-called stereotactic operation must be carried out. This is a minimally invasive procedure in which the head is fixed in a stereotactic frame under local anesthesia. The stereotactic frame is used to keep the head in an exact position.

A CT examination of the head makes it possible to create a patient-specific coordinate system that serves as a reference for integrating the MRT images. In this way, an almost distortion-free coordinate system can be created.

The skull is then opened with a drill under local anesthesia and combined stimulation and lead microelectrodes are inserted up to 10 mm in front of the selected target point. The target points (e.g. subthalamic nucleus-STN) are determined via electrophysiological measurements by deriving and amplifying the electrical nerve cell activity. Neurological exams may be repeated throughout the procedure as patients are awake. This way you can control the effects of the stimulation.

At the destination now determined, the final four-pole stimulation electrode is introduced under X-ray control, anchored in the borehole and the final electrode position is documented by an X-ray image. After removing all instruments and devices, the skin wound is closed and the stereotaxic frame is removed.

After the operation

A test phase of several days with an external remote control now begins in order to test the effect of the deep brain stimulation under everyday conditions. In addition, the final position of the stimulation electrodes is checked by means of an MRT examination.

Implantation of the pulse generator

If the test stimulation is successful and the treatment effect can be successfully and constantly repeated, the pulse generator is implanted in a second surgical procedure under general anesthesia under the skin in the area of ​​the collarbone. In individual cases, the generator is implanted during the first surgery.

Follow-up treatment and rehabilitation deep brain stimulation (DBS)

The operation is followed by physiotherapy and rehabilitative measures for 3-4 weeks.

Duration of Incapacity for Work Deep Brain Stimulation (DBS)

Business activities can be resumed 3-4 weeks after the operation.

Taking up physical activity deep brain stimulation (DBS)

Sport can be resumed 3-4 weeks after the operation.

Results and Risks of Deep Brain Stimulation (DBS)

The risk of intracranial bleeding in the context of deep brain stimulation varies in the literature between 0,6% and 3,5%. The rate of infections and wound healing disorders is 2,5%. Implant-specific mechanical or technical complications are reported in 5,8-17,7% of the cases. Undesired motor or psychomotor effects occur more frequently in the initial phase of stimulation. However, these are usually not pronounced and respond well to a change in the stimulation parameters. The rate of complications is falling continuously due to the technological advancement, the improvement of the imaging and the optimized process flows.