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DEEP BRAIN STIMULATION

Increasing number of movement disorders are being reported all over the world. Movement disorders are neurological conditions that affect the speed, fluency, quality, and ease of movement. Movement disorders include the following conditions :

  • Ataxia (lack of coordination, often producing jerky movements)
  • Dystonia (causes involuntary movement and prolonged muscle contraction)
  • Huntington's disease (also called chronic progressive chorea)
  • Multiple system atrophies
  • Myoclonus (rapid, brief, irregular movement)
  • Parkinson's disease
  • Progressive supranuclear palsy (rare disorder that affects purposeful movement)
  • Restless legs syndrome (RLS) and reflex sympathetic dystrophy/periodic limb movement disorder (RSD/PLMD)
  • Tics (involuntary muscle contractions)
  • Tourette's syndrome
  • Tremor (e.g., essential tremor, resting tremor)
  • Wilson disease (inherited disorder that causes neurological and psychiatric symptoms and liver disease)

Of these, Parkinson's disease is perhaps the most known disease of the nervous system. Parkinson’s disease is a progressive disorder of the nervous system. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But, while a tremor may be the most well-known sign of Parkinson's disease, the disorder also commonly causes stiffness or slowing of movement.

One of the most advanced treatments of movement disorders - including Parkinson’s disease - is Deep Brain Stimulation (DBS). It is a surgical procedure used to treat essential tremor and dystonia. At present, the procedure is used only for individuals whose symptoms cannot be adequately controlled with medications.

DBS uses a surgically implanted, battery-operated medical device called an implantable pulse generator (IPG) - similar to a heart pacemaker and approximately the size of a stopwatch - to deliver electrical stimulation to specific areas in the brain that control movement, thus blocking the abnormal nerve signals that cause PD symptoms.

Before the procedure, a neurosurgeon uses magnetic resonance imaging (MRI) or computed tomography (CT) to identify and locate the exact target within the brain for surgical intervention. Some surgeons may use microelectrode recording - which involves a small wire that monitors the activity of nerve cells in the target area - to more specifically identify the precise brain area that will be stimulated.

The DBS system consists of three components: the electrode, the extension, and the IPG. The electrode—a thin, insulated wire—is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is positioned within the specific brain area.

The extension is an insulated wire that is passed under the skin of the head, neck, and shoulder, connecting the electrode to the implantable pulse generator. The IPG (the "battery pack") is the third component and is usually implanted under the skin near the collarbone. In some cases, it may be implanted lower in the chest or under the skin over the abdomen.

Once the system is in place, electrical impulses are sent from the IPG up along the extension wire and the electrode and into the brain. These impulses block abnormal electrical signals and alleviate PD motor symptoms.

It may take a few weeks until the simulators and medications are adjusted sufficiently for patients receive adequate symptom relief. But, overall, DBS causes very few side effects and is one of the safest, most advanced and currently the most effective treatment for Parkinson’s Disease and other Movement Disorders.

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