Deep Brain Stimulation (DBS) is a neurosurgical procedure that has been used successfully for people with certain types of dystonia for around fifteen years. It is not a cure but it is a valid treatment option. Initially a surgical treatment for Parkinson’s disease, it is now used for many different neurological and psychiatric conditions.
In the surgical procedure for dystonia the patient is usually asleep whereas in DBS for Parkinson’s disease the patient is awake. Small electrodes are implanted deep in the brain, the target being in an area of the basal ganglia called the globus pallidum, although different target areas are being trialled. The target is identified by the neurologist/neurosurgeon who interpret the type of electrical signals they receive from the electrodes as they are positioning them.
When the neurologist/neurosurgeon are confident the electrodes are in position they are connected to a lead that is tunnelled under the skin from the head, behind the ear and down the side of the neck. From there they are connected to a pacemaker-like device, called a stimulator, also under the skin usually on the chest wall. It is not completely understood how the device works but it is thought that when the electrodes are stimulated they disrupt or inhibit the abnormal activity coming from the area of the basal ganglia where the electrodes are placed.
DBS has been used successfully in certain types of dystonia, including some generalised dystonias such as early onset generalised dystonia, and in cases of neck dystonia that do not respond to other treatment options. Recovery time varies depending on many factors, in particular the type of dystonia and the age of the patient but many people are discharged a few days after the procedure.
The settings for the stimulator are controlled by a hand-held computer and the settings altered by the specialist until a good result is reached. This may take some time and trial and error. . Patients are often given their own hand-held computer that allows them to make small changes between visits to the specialist. In dystonia stimulation of the electrodes reduces the abnormal movements and postures.
As with all medical procedures there are risks. In DBS there is around a 2-4% risk of stroke or infection. The specialists and the anaesthetist will explain the risks prior to you signing consent for the procedure. These risks need to be balanced with the expected benefits of the surgery so that you can make an informed decision.
As some types of dystonia respond better than others you need to discuss the possibility of success with your specialist if you are considering DBS.
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