deep brain stimulation

Chronic deep brain stimulation is a rapidly emerging therapy for advanced Parkinson disease . Deep brain stimulation surgery technique involves implanting electrodes inside the deep nuclei of brain called as subthalamus. These electrodes are then connected to IPG (Pacemaker) implanted underneath the skin below the clavicle through the connecting leads. To perform any kind of activity, the patient has to switch on the device with the help of a patient programmer. This stimulates the deep brain nuclei, which results to regression of tremor and stiffness. The pacemaker can be switched off when not required

With the progress of deep brain stimulation disease the parameters of stimulation are changed over a period of time so that patients can remain symptom free for long period of time. The patient himself can change the stimulation parameters with the help of patient programmer. Normally the life of the pacemaker is five years and after that a new pacemaker replaces it. The electrodes remain in position for life long. The stimulation of subthalamic nucleus through this device leads to improvement in all the symptoms of advanced Parkinson disease. Implanting the brain electrode in vim nucleus of thalamus can effectively treat all the types of tremor.

Deep Brain Stimulation Surgery Advantages :

Following are the advantages of deep brain stimulation surgery

1. Non destructive Does not necessitate making lesion (Breaking of little brain circuit) in the brain and hence no side effect.

2. Completely reversible Patient will come back in same condition once the device is switched off.

3. Deep brain stimulation surgery is Fully Programmable.

Reduction of antiparkinson medication There is significant reduction of antiparkinson medication (50-75%) after stimulation and hence there is improvement in all drug induced side effects like abnormal movements, ghabarahat, hallucinations and BP fluctuation etc.

Bilateral procedures can be performed at the same sitting.

There is improvement of quality of life in both off and on stage of the disease.

So Far Forty Five deep brain stimulation surgeries were performed successfully by Dr.Alok Gupta Consultant Neurosurgeon

Deep Brain Stimulation Surgery Technique :

Patient is kept off medication for 12 hrs.
A small burr hole is made in right coronal region one day prior to surgery for the ventriculography.
On the day of surgery Leksell Stereotactic frame is fixed under local anesthesia, and then patient is taken to Radiology Department for CT Scanning and Ventriculography.
The subthalmic target is calculated by CT Scan and ventriculography. Subthalamic target lies 9mm in front of posterior commissure , 11mm lateral to midline and 4-6 mm below the AC-PC plane.
In the operation theatre, Micro electrode recording is done using 5 channel lead point MER. After analyzing the recording of MER, the track which has longest and strongest signal of sub thalamus chosen for the stimulation to confirm the desired clinical outcome in form of reduction of tremor, stiffness and appearance of dyskinesia.
DBS lead is placed in that track using C-arm.
DBS lead is connected to IPG (Kinetra) under general anesthesia. This procedure is done on the same day or after 2 days.
After the Deep Brain Stimulation electrodes implantation, the next important step of this surgery is programming. Initial programming is done in two weeks time and later-on further programming is done as out patient basis in subsequent visits.

The sub thalamus nuclei on both side is stimulated with varying combination of pulse width, frequency and voltage to get the desired effects. Patient can himself programme using hand held patient's programmer under guidance of a neurologist or Medtronic representative.

Programming outside India is arranged after contacting local Medtronic representative

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For more details contact Dr.Alok Gupta at
guptaa@ndf.vsnl.net.in ,guptaa@parkinsonindia.org

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