Deep Brain Stimulation: A Pacemaker for the Brain
Deep brain stimulation has been used for many years for treating essential tremors and other symptoms of Parkinson’s disease. Earlier this year, Epworth Richmond implanted a DBS device on its first patient, who travelled from Western Australia to have the surgery. We look at what deep brain stimulation involves and how the first patient fared from it.
Deep brain stimulation involves implanting a device called a neurostimulator to send impulses through electrodes to send information to target sites on both sides of the brain. The neurostimulator is attached via an extension wire that runs under the skin to connect the device to electrodes in the brain.
The idea is to interfere with or block electrical signals from parts of the brain causing the symptoms, without damaging healthy brain tissue. The intensity of the impulses can be raised or lowered depending whether the symptoms reappear or are diminished.
Essentially, deep brain stimulation is the equivalent of a heart pacemaker for the brain.
According to Epworth Richmond’s medical director, Associate Professor Bruce Waxman, DBS surgery has undergone significant changes in the past five years, which include reducing operating times and surgical complications. Epworth is excited to offer this procedure to patients for the first time.
The benefit is being able to reduce medication and associated side-effects for controlling the symptoms, or work where medication has been unable to help control symptoms.
Epworth’s first of many patients to subsequently have a deep brain stimulation device implanted, Harrie Martens from Albany in Western Australia, has a new lease of life. DBS has been used to help manage his essential tremor.
Harrie found his tremor was profoundly affecting many parts of his life, including simple things such as writing, using the computer and fishing.
“It restricted me pretty badly. I was becoming a bit of a hermit because it is hard to go out when you are shaking all of the time,” Harrie says.
Harrie travelled to Melbourne for the procedure to avoid the eight-month waiting period in the WA public health system for the DBS surgery.
Epworth neurosurgeon Mr Girish Nair worked with Epworth neurologist Dr Andrew Evans to surgically implant the DBS device, lead and extension in a four hour operation in March 2015.
The first part of deep brain stimulation surgery involves using specialised MRI and CT imaging to plan the precise location to place the electrode . The operation involves use a head frame which helps to ensure the accuracy of lead placement. The patient is awake during this part, and the neurologist and neurosurgeon work together to find the best placement for the electrodes and work with the patient to ensure they are targeting the correct area.
The second part of the surgery includes attaching the extension wire under the skin to the neurostimulator. This is performed with the patient under general anaesthetic.
The neurostimulator device may be activated immediately at low levels, then monitored over a number of weeks to find the best settings on each patient.
With a hospital stay of just two days, Harrie was able to return to WA after his surgery and subsequent reviews. The 65-year-old retiree is now looking to get back to normal life without the restrictions his tremor placed on his lifestyle, having experienced a substantial reduction in his tremor.
Research is also underway in other applications for deep brain stimulation, including epilepsy and depression.
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