Do you have a hand that shakes so much that you can't even hold a cup of tea properly? Do you feel shaky when writing, or when signing? This is what we call 'Essential Tremor'. Even if you try to control this condition by taking medication, some people may not be satisfied with it. So for such people, today we are going to talk about a very advanced treatment method to control this tremor. That is deep brain stimulation , or DBS treatment for short.
Simply put, what is Deep Brain Stimulation (DBS)?
Deep Brain Stimulation (DBS) is a technique used to treat a number of movement disorders, particularly essential tremor.
There is a part of our brain called the thalamus. Think of it as a central control center that coordinates and controls the actions of our body's muscles. Although the exact cause of Essential Tremor is not known, it is believed that the abnormal brain activity that causes tremors passes through this thalamus.
DBS treatment involves surgically implanting several very fine electrodes in a part of the brain called the thalamus. These electrodes are then connected by wires to a small device that is implanted under the skin, just below the collarbone. This device is like a pacemaker in the heart. We call it an impulse generator (IPG).
Once the device is activated, it continuously sends small , painless electrical pulses to the thalamus, blocking the abnormal signals that cause tremors. This helps control tremors without damaging any part of the brain.
Simply put, this is like turning off a malfunctioning 'switch' in the brain, but without causing any damage to the brain.
This IPG device can be easily programmed (prog RA m) via radio signals via a computer. Also, the patient is given a special magnet, which can be used to turn the device on/off from the outside. The battery of this device can usually be used for three to five years. The battery replacement surgery is also very simple.
What are the advantages and disadvantages of this DBS treatment?
Like any medical treatment, this one has both advantages and disadvantages. Let's take a look at them.
| Advantages | Disadvantages |
|---|---|
| The brain tissue is not permanently destroyed, so it will not hinder new treatments in the future. | There is a risk of infection because something foreign is inserted into the body. |
| This device can be surgically removed at any time. | You have to have surgery again to replace the battery every 3-5 years. |
| The functionality of the device can be adjusted as needed. | Sometimes there may be discomfort or strange sensations during stimulation. |
| It may be more effective in controlling tremors than surgeries that destroy parts of the brain (thalamotomy). | - |
Who should consider DBS surgery?
This is a very important question. Before considering DBS, you should have tried all of the prescribed medication options . If your condition is well controlled with medication or other external devices, surgery is not recommended.
Before deciding whether this is right for you, you should discuss these matters thoroughly with a movement disorders expert or a neurologist who is specially trained in this area. Your doctor is the best person to advise you on this.
What happens during the surgery?
You will not be put to sleep during the operation. Instead, you will be in a kind of "twilight" state. This is because the surgical team will need to talk to you and check the effects of the stimulation. You will be given a local anesthetic to numb the sensitive areas and not feel any pain. This is why most people feel very little discomfort during the operation.
Doctors use a CT or MRI scan to map the exact location of the electrodes in the brain. Once the correct location is identified, permanent electrodes are implanted in the brain. Then, wires are brought under the skin of the scalp and connected to an IPG device implanted under the skin of the chest.
The IPG is turned on and adjusted two to four weeks after surgery. It may take several more weeks to adjust the device and the medications you are given to get the right amount of relief for your symptoms .
What to expect after surgery?
After the surgery, you may feel a little tired and have some body aches. However, you will be given medication to help you stay comfortable. There may be some pain or tenderness around the stitches and pin sites.
How do you take care of your wounds after you get home?
- Your stitches or staples will be removed 7-10 days after surgery.
- The four places where the nails were stuck on the head should be covered with Band-Aids at all times until they dry. If necessary, change them every day.
- You can clean your head with a damp cloth, avoiding areas with sores .
- You can shampoo your hair the day after the stitches are removed, but be very careful . Do not scratch or pick at the wounds.
Do you want to limit your work?
- Stay away from light activities like housework and sexual activity for two weeks after surgery.
- Avoid strenuous exercise such as jogging and swimming for four to six weeks after surgery.
- Do not lift anything heavier than five pounds (2.3 kg) for at least two weeks.
- Depending on the nature of your job, you may be able to return to work within four to six weeks.
Special Attention: Call the doctor immediately!
If you experience any of the following symptoms after surgery, you should contact your doctor immediately without delay .
| Warning Signs | |
|---|---|
| 1. | Severe and persistent headache. |
| 2. | Bleeding from the wound. |
| 3. | Increased redness or swelling around the wound. |
| 4. | Loss of vision or sudden change in vision. |
| 5. | A persistent fever of over 101 degrees Fahrenheit. |
Take-Home Message
- Deep Brain Stimulation (DBS) is an advanced treatment for severe essential tremor that is difficult to control with medication.
- This does not destroy parts of the brain, but provides electrical stimulation to block the wrong signals that cause tremors.
- This device can be adjusted as needed and removed if necessary.
- As with any surgery, there are pros, cons, and risks. It is important to discuss all of these carefully with your specialist before making a decision.
- Following your doctor's instructions exactly after surgery is very important for a speedy recovery and successful results.
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