What is Deep Brain Stimulation (DBS)?

Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) is a neurosurgical procedure that involves the implantation of electrodes into specific brain targets to deliver precise electrical stimulation, modulating neural activity to achieve therapeutic effects for patients with medication-refractory neurological and psychiatric disorders. 1

What is DBS and How Does it Work?

DBS is an implantable electrical device system consisting of three main components:

1. Electrodes - Surgically implanted into specific brain targets
2. Extension wires - Connect the electrodes to the pulse generator
3. Pulse generator - An implanted device (similar to a pacemaker) that delivers programmed electrical stimulation

The system works by delivering controlled electrical pulses to targeted brain regions, altering or modulating neural functioning in a reversible and adjustable manner. 2

Clinical Applications

DBS has established therapeutic applications in several conditions:

• FDA-approved indications:

  • Parkinson's disease (typically targeting the subthalamic nucleus)
  • Essential tremor (typically targeting the thalamus)
  • Dystonia (typically targeting the globus pallidus) 1

• Investigational applications:

  • Obsessive-compulsive disorder (OCD)
  • Major depressive disorder
  • Epilepsy
  • Addiction
  • Alzheimer's disease
  • Traumatic brain injury 3, 2

Patient Selection and Procedure

DBS is typically reserved for patients who:

• Have failed to respond adequately to medical management
• Experience intolerable medication side effects
• Develop complications from medical therapy 1

The procedure involves:

1. Preoperative imaging and planning
2. Stereotactic neurosurgical implantation of electrodes
3. Intraoperative microelectrode recordings and behavioral testing (often performed with the patient awake) 4
4. Implantation of the pulse generator (usually in a second procedure)
5. Programming and adjustment of stimulation parameters

Advantages Over Previous Treatments

DBS offers significant advantages over older lesioning procedures:

• Reversibility - Effects can be stopped by turning off stimulation
• Adjustability - Stimulation parameters can be modified to optimize therapy
• Bilateral application - Can be safely used on both sides of the brain
• Good safety profile - Lower risk of permanent adverse effects 1, 2

Risks and Complications

The main risks associated with DBS include:

• Intracranial bleeding (≤5% at experienced centers)
• Infection
• Electrode malposition
• Hardware issues (migration, disconnection, malfunction)
• Stimulation-related side effects (which can usually be managed by adjusting parameters) 1

Current Status and Future Directions

DBS technology continues to evolve with several promising developments:

• Directional electrodes - Allow steering of current in specific directions for more precise stimulation
• Closed-loop systems - Can record and interpret brain activity and automatically adjust stimulation parameters
• Advanced imaging techniques - Improve targeting accuracy and patient-specific approaches
• New brain targets - Exploration of novel targets for existing and new indications 5

Important Considerations

It's important to note that DBS remains at an investigational stage for psychiatric disorders, including OCD, despite showing promise. According to consensus guidelines, experienced multidisciplinary teams are mandatory for the safe and ethical conduct of psychiatric neurosurgery, ensuring:

• Documented refractoriness of patients to standard treatments
• Proper consent procedures that respect patient capacity and autonomy
• Comprehensive preoperative and long-term postoperative follow-up
• Systematic reporting of both effects and side effects 3

DBS represents a significant advancement in the treatment of neurological disorders, offering hope to patients who have exhausted conventional treatment options while providing researchers with unique opportunities to study brain function and pathology.