The ipg can removed and the dbs procedure can halted

What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a surgical procedure used to treat disabling symptoms of neurological disorders, including dystonia, epilepsy, essential tremor, and Parkinson’s disease. 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, which blocks the abnormal nerve signals that cause symptoms.

Before the procedure, a neurosurgeon uses noninvasive diagnostic imaging—either magnetic resonance imaging (MRI) or computed tomography (CT) scanning—to identify and locate the exact target in the brain for the surgery. Most surgeons use
microelectrode recording—which involves insertion of a tiny wire that monitors the activity of nerve cells—to more specifically identify the precise brain area that will be stimulated.

For treatment of Parkinson’s disease, DBS targets parts of the brain that play a role in the control of movement—the thalamus (which relays and integrates sensory and motor information), subthalamic nucleus (which helps direct movement preparation), or globus pallidus (which helps regulate intended movement). DBS for dystonia specifically targets the globus pallidus interna (involved in the regulation of voluntary movement), while DBS for essential tremor targets the thalamus. Different areas of the brain may be targeted for individuals with epilepsy who don’t respond well to other therapies.

DBS is used to treat the most commonly debilitating motor symptoms of Parkinson’s disease (PD) such as rigidity, slowed movement, stiffness, tremor, and problems walking. It is used only for individuals whose symptoms cannot be adequately controlled with medication. However, only people who improve to some degree after taking medication for Parkinson’s benefit from DBS. A variety of conditions may mimic PD but do not respond to medication or DBS.

Most people with PD still need to take medicine after undergoing DBS, but many people experience considerable reduction of their motor symptoms and may be able to reduce their medications. The degree of reduction varies by individual but can lead to a significant improvement in side effects such as dyskinesia (involuntary movements caused by long-term use of levodopa). In some cases, the stimulation itself can suppress dyskinesia without a reduction in medication. DBS does not improve cognitive symptoms in PD and may worsen them. Therefore, it is not generally used if there are signs of dementia. DBS does not slow the progression of the neurodegeneration.

DBS targeting the thalamus can improve the involuntary movement of the arms, hands, and head that is associated with essential tremor.

Epilepsy

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Are there advantages to DBS?

Side effects of the stimulation may include numbness or tingling sensations, behavioral changes, as well as balance or speech problems.

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Other NINDS researchers are collecting data on the physiology and effectiveness of DBS therapy and motor and cognitive function in people with either Parkinson’s disease, dystonia, or essential tremor who don’t respond to other treatment. Data will include the change in motor symptoms measured before and three months after treatment. Intra-operative electrode recordings will investigate the neurophysiological mechanisms of DBS and explore the neural circuits essential for motor and cognitive processing in the basal ganglia.

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Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke National Institutes of Health
Bethesda, MD 20892