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In deep brain stimulation (DBS), electrodes are implanted within the brain to deliver a continuous low electric current to the target area. The current is passed to the electrodes through a wire running under the scalp and skin to a battery-powered pulse generator implanted in the chest wall.
The movement disorders of PD and ET are due to loss of regulation in complex circuits within the brain that control movement. While the cause of the two diseases differ, in both cases, certain parts of the brain become overactive. Surgical treatment can include destruction of part of the overactive portion, thus rebalancing the regulation within the circuit. It was discovered that the same effect could be obtained by electrically stimulating the same areas, which is presumed to shut down the cells without killing them.
DBS may be appropriate for patients with PD or ET whose symptoms are not adequately controlled by medications. In PD, this may occur after five to ten years of successful treatment. Continued disease progression leads to decreased effectiveness of the main treatment for PD, levodopa. Increasing doses are needed to control symptoms, and over time, this leads to development of unwanted movements, or dyskinesias. Successful DBS allows a reduction in levodopa, diminishing dyskinesias.
For PD, deep brain stimulation is performed on either the globus pallidus internus (GPi) or the subthalamic nucleus (STN). Treatment of essential tremor usually targets the thalamus. Each of these brain regions has two halves, which control movement on the opposite side of the body: right controls left, and left controls right. Unilateral (onesided) DBS may be used if the symptoms are much more severe on one side. Bilateral DBS is used to treat symptoms on both sides.
DBS is major brain surgery. Bleeding is a risk, and patients with bleeding disorders or who are taking blood thinning agents may require special management. DBS leaves metal electrodes implanted in the head, and patients are advised not to undergo diathermy (tissue heating) due to the risk of severe complications or death. Diathermy is used to treat chronic pain and other conditions. Special cautions are required for patients undergoing MRI after implantation.
Author Info: Richard Robinson, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Neurological Disorders, 2005This feature is for informational purposes only and should not be used to replace the care and information received from your healthcare provider. Please consult a healthcare professional with any health concerns you may have.
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