The Deep Brain Stimulation (DBS) Therapy – How Much do we Really Know About it

chillibreeze writer — Bijli Nanda

Deep Brain Stimulation or DBS as it is commonly known involves delivery of high frequency stimulation to the brain. Electrodes are placed at appropriate sites in the brain, and connected via leads under the skin of the neck, to a pulse generator implanted mostly in the skin under the clavicle. The parameters of the stimulation are regulated by the pulse generator. DBS has traditionally been used mostly for movement disorders refractory to other forms of treatment. Some of the disorders are Parkinson’s disease, essential tremor and dystonia. The placement of the electrodes depends on the disorder in question, for e.g., in Parkinson’s disease the most common site is the Globus pallidus, whereas in Tourette’s disorder the ventromedial nucleus of the thalamus has shown good results.

Before the era of DBS, surgical removal used to be the treatment for such disorders; strangely, electrical stimulation has the same effect as removal of the same structure. Hence, some authors have suggested that stimulation acts by functional ablation. A number of mechanisms have been proposed, like depolarization blockade, synaptic inhibition, synaptic depression, and stimulation – induced modulation of pathologic network activity, but not a single one seems to be able to explain its effect in all the disorders where it has been used. Some researchers have suggested that it may be a combination of these. However, till date it is not really known how DBS works. That doesn’t deter medical practitioners from using it almost blindly for more and more disorders like epilepsy, chronic pain and obsessive compulsive disorder. Lately it has also been tried for refractory depression.

Since similar results are obtained with surgical ablation and DBS, what is it that makes practitioners go for DBS rather than for surgical removal or lesioning? For one, DBS is reversible and it can be switched on and off by the patients themselves depending on their symptoms. It is essentially a blind surgical procedure done under local anesthesia, where electrodes are placed in the brain depending upon where the patient gets maximum symptomatic relief, so the degree of precision is more, plus the results can be seen during the procedure itself. Moreover, stimulation parameters for DBS can be frequently adjusted by the nurse or technician, to match the needs of patients. Surgical ablation doesn’t have these advantages, on top of which its side effects are permanent. DBS too has its fair share of side effects, mostly neuropsychiatric, like hallucinations, depression and apathy, but these usually go away on stopping the stimulation. Disorders like Parkinson’s need intervention time and again as they progress, and this aspect cannot be addressed by initial surgical ablation so at least in progressive disorders, DBS seems to be a better bet. DBS seems to be the more attractive option for other disorders too, as both DBS and surgical treatment only give symptomatic relief and in any case do not treat the disorder itself.

DBS is one of the most miraculous therapies in the medical field. It works in a wide array of neurological and psychiatric disorders and its benefits are so overpowering that what we don’t know (its mechanism of action), doesn’t seem to matter. However, it is still a relatively novel therapy, and we would do well to exercise some caution with its use, till more is known about it.

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—About our writer:

Bijli,

She is a doctor with a specialization in Physiology. She did a postdoctoral Fellowship from the prestigious Emory University and has been in the research field for 5 years. She spent so much time reading and writing research articles that she decided to take it up as a full time career recently. Her special interest is neurosience.

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