Deep brain stimulation is a surgical therapy that can be used for Parkinson's, among other things. How it works and which patients are eligible.
- With deep brain stimulation, electrical impulses improve brain activity in disturbed brain regions.
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Deep brain stimulation (also brain pacemaker or deep brain stimulation / DBS) is to be assigned to the operative therapy methods. It can help alleviate symptoms in various neurological conditions. These include, above all, Parkinson's disease, essential tremor (tremors unrelated to an underlying disease) and dystonia (disturbed state of tension in muscles and vessels), as in Huntington's chorea. In exceptional cases, it can also be used as a treatment option for multiple sclerosis, depression and certain forms of epilepsy.
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How deep brain stimulation works
In deep brain stimulation, electrodes are inserted into deep brain regions via a small hole in the skull, which remain there. The electrodes are controlled by a pulse generator, which is implanted under the skin near the clavicle, similar to a pacemaker. The impulses sent from there permanently influence the disturbed brain region. This improves symptoms such as tremor and has the advantage that the best possible setting for the patient can be achieved by regulation at any time.
Deep brain stimulation was used for the first time in 1983 and has been available to sufferers as a further treatment option at a few university hospitals in Germany for several years. If necessary, the treatment in neurology is completely covered by the health insurance companies.
Prerequisite: medication no longer helps
Basically, deep brain stimulation is suitable for Parkinson's patients, who can no longer alleviate symptoms with drug treatment, or for those who suffer from very severe side effects of the drugs.
Furthermore, the treatment method is very suitable for sufferers with severe tremor that restricts everyday life. In people with movement disorders due to dystonia, such as MS, the brain pacemaker can only be used if several extremities are affected, the symptoms do not result from brain damage and medication cannot be improved.
Overall, the patients must be in good general physical and mental condition. During a stay in a clinic, a neurologist will carry out careful examinations in order to be able to make a surgical recommendation in the first place.
It is estimated that around 20 percent of all Parkinson's patients across Europe could benefit from deep brain stimulation, but it is only available to less than seven percent of those affected. Due to the different regulations for the assumption of costs in the European countries, the lack of exchange among specialists and little knowledge of non-drug treatment options for general practitioners, this treatment is still not offered to many patients.
Deep brain stimulation for depression
For some years now, clinical studies have been investigating how this method works against otherwise therapy-resistant, chronic depression. In some cases, antidepressant effects were found in 21 to 75 percent of the test subjects. The positive effect increased with the duration of the application.
Deep brain stimulation can be combined with drug and psychotherapeutic procedures. However, too few psychiatric patients have been treated with a brain pacemaker to be able to make general statements. The mechanism of action is not yet fully known. Caution should also be exercised because of the possible increased risk of suicide, which is already increased in patients with severe depression.
Surgery under neurological control
The risks associated with deep brain stimulation are low. The operation is performed under neurological control with local anesthesia and takes about 20 minutes. Since the patient is awake, problems can be recognized immediately during the operation and countermeasures can be initiated. Bleeding rarely occurs when the electrodes are inserted. However, the risk of permanent damage is less than three percent.
Side effects and risks of deep brain stimulation
If the electrode is not placed in the correct place during deep brain stimulation, side effects can occur. The side effects can be temporary or permanent. Possible are:
- Speech disorders
- Feeling disorders
- Muscle spasms
- Double images
- psychiatric side effects such as apathy, depressive mood or submaniac conditions (in Parkinson's patients)
As with any surgery, another risk is that an infection will occur. There is also a risk of bleeding in the brain, but this risk is extremely low at around one percent.
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