Deep brain stimulation

Dr Henry Knipe and A.Prof Frank Gaillard et al.

Deep brain stimulation is used in a variety of clinical settings, predominantly in patients with poorly controlled movement disorders. Although effective, its exact mode of function continues to be poorly understood 2.  

Careful patient selection and target selection are essential if the procedure is to have good efficacy.

  • Parkinson disease
    • subthalamic nucleus 1
    • pedunculopontine nucleus
    • globus pallidus (pars interna)
  • severe essential tremor
    • ventral intermediate nucleus 2
  • dystonia (cervical dystonia and tardive dystonia) 4
    • globus pallidus (pars interna)
  • cluster headaches 6
    • hypothalamus
  • chronic pain 5
    • thalamus
    • periaqueductal grey matter
  • neuropsychiatric disorders: largely experimental 4
    • Tourette syndrome
      • centromedian parafascicular complex (thalamus)
    • medically refractive depression
      • white-matter tracts adjacent to cingulate gyrus
      • nucleus accumbens
    • obsessive-compulsive disorder
      • anterior limb of internal capsule
      • subthalamic nucleus
      • striatum

A stereotactic frame is applied and imaging obtained to enable accurate target selection. With the aid of multi-planar reformats and operative stereotaxis, a burr-hole is made for each probe and the electrode passed to the desired target, avoiding the lateral ventricles, vessels and sulci. Intraoperative stimulation is then performed to ensure adequate positioning. Leads are tunnelled under the skin and the internal pulse generator implanted in a similar location to a pacemaker.

Complications can be immediate or delayed 12

  • immediate
    • hemorrhage (~1.5%)
    • infarction
    • local brain parenchymal edema (~3%)
      • unilateral or bilateral
      • 4-120 days post-operatively
      • asymptomatic or present with headache, seizure
  • delayed
    • infection (~12.5%): most commonly the pulse generator pocket
    • lead fracture (~10%)

Side effects predominantly relate to the stimulation itself, which may lead to dysarthria, disequilibrium, motor disturbances and paraesthesia. These symptoms will of course vary with the exact location of the probes.

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Article information

rID: 7896
Section: Gamuts
Synonyms or Alternate Spellings:
  • Deep brain stimulation (DBS)
  • Deep brain stimulators

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Cases and figures

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    Case 1: DBS for Parkinson disease
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  • Case 1: DBS for Parkinson disease
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  • Case 2: the IPG of a neurostimulator
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  • Case 3: bilateral stimulators
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  • Case 4
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  • Case 5: displaced deep brain stimulators
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