Electrical signals to the brain? What is Deep Brain Stimulation (DBS)? Let's talk!

Have you ever seen someone whose limbs are shaking and unable to walk properly, whose seizures are difficult to control with medication? Or someone who suffers from epilepsy that cannot be controlled even with medication? We can't even imagine how difficult it is to live with such conditions. But with the advancement of medical science, there are now new treatments that can provide relief to such patients. Today, we are going to talk about one such special treatment. That is Deep Brain Stimulation, or DBS treatment for short.

Simply put, what is Deep Brain Stimulation (DBS)?

This name sounds a little scary, doesn't it? You might be thinking, "Is it like giving electricity to the brain?" In fact, it's explained simply as follows. DBS is a surgical procedure that sends very subtle electrical signals to a specific, deep part of the brain. Just like a pacemaker is implanted to restore normal heart function when the heart is irregular, you can think of this as a pacemaker that is placed in the brain .

What happens is that very thin wires (called electrodes) are inserted into the brain where the problem is. The wires are then connected to a small battery-like device (called a pulse generator) that is implanted under the skin near your collarbone. The device sends out tiny electrical signals to stimulate the brain cells. These electrical signals cause the brain to start working normally again.

Why do we need this DBS treatment?

Our brain is an amazing place where billions of nerve cells, or neurons, work together. These neurons communicate with each other through electrical and chemical signals. Imagine that when you want to raise your hand, the corresponding signal goes from the brain to the hand through this network of neurons.

However, due to some diseases, the activity of these neurons in some parts of the brain decreases or becomes irregular. Then, the body's functions controlled by that part cannot be carried out properly. For example, if the neurons in the part that controls movement do not work properly, things like trembling in the limbs and difficulty walking may occur.

DBS therapy works by artificially delivering subtle electrical signals to reactivate these dormant neurons. This can provide significant relief from symptoms. However, researchers are still studying exactly how this happens.

What conditions are successfully treated with DBS?

DBS therapy is mainly used to treat several diseases related to brain function. Among these diseases, this treatment has been proven to be very effective. Let's take a look at what they are.

What happens before surgery?

If you decide to have DBS surgery, there are several steps you need to take to prepare for it.

1. Discussion with the doctor: First, your doctor will explain all the advantages, disadvantages, and risks of this surgery to you. This is the best time to get answers to all your questions.

2. Medical tests: Several tests, such as MRI and CT scans, are performed to see if your body is in a suitable condition for this surgery. The surgeon uses the images from these scans to determine the best place to place the electrode in your brain.

3. Medication Awareness: You should tell your doctor about any medications you are currently taking, especially blood thinners . He or she may advise you to stop taking certain medications for a while before surgery. Never stop taking any medications without talking to your doctor first.

4. Fasting: Since the surgery will be performed under general anesthesia, you will be advised to abstain from food and drink for a few hours before the surgery (fasting).

What happens during the surgery?

DBS treatment is not really a single surgery. It is usually a series of two or three surgeries performed on different days.

Step One: Implanting Electrodes in the Brain

This is the most important surgery.

• First, your hair is shaved. Then, your head is placed in a special frame to keep it still. You are given a sedative to make you feel dizzy, so you won't remember it.
• Then, a CT scan is performed to identify the correct route for inserting the electrode.
• The surgeon injects medicine to numb the scalp and skull, and then makes a very small hole in the skull.
• At this time, especially if you are being treated for movement disorders like Parkinson's, you may be awakened . Don't be afraid of this. You will not feel any pain, because our brains are not capable of directly sensing pain .
• While you're awake, the doctor will ask you to do small things. For example, answer questions, look at pictures, and move your arms and legs. This is to make sure the electrodes are in the right place on your brain.
• Once the electrode is properly placed, the exposed end is brought under the skin at the back of the head and temporarily covered with a plastic sheet. The incision is then stitched shut. You usually stay in the hospital overnight and can go home the next day.

Step Two: Implanting the Pulse Generator

This surgery is usually done on a separate day after the first surgery. You will be fully anesthetized.

• The surgeon makes a small incision in your skin just below your collarbone.
• A small space (pouch) is created under the skin and the pulse generator, which is like a battery, is placed inside it.
• Then, another wire (extension wire) is passed under the skin from the electrode on the head to connect to this pulse generator.
• All of this is connected and the incision is sewn up. Since this is a relatively simple surgery, you can go home the same day.

What happens after the surgery?

After the surgery is over, the most important part begins: programming the device .

A few weeks after surgery, your doctor will call you in. That's when the pulse generator will be turned on and programmed.

This is like tuning a radio to a specific channel. You need to adjust the settings of the electrical signals to provide maximum relief for your symptoms and minimize side effects. This may require several visits to the doctor.

The batteries in these pulse generators usually last 3-5 years. Some can be recharged, and they can last up to 9 years. Changing the battery also requires a minor surgery, but it is much simpler than the initial surgery.

What are the benefits of DBS treatment?

• A good option for patients who cannot be controlled by medication: DBS is a great hope for life when medication is not working or the side effects of medication are unbearable. It also helps reduce the dosage of medication for Parkinson's patients.
• A life-changing treatment: For someone who was unable to perform even basic tasks due to severe symptoms, it is a great thing to be able to do their work on their own again.
• Adjustable: If your condition changes over time, you can adjust the settings of the pulse generator to suit.
• Reversible: If this treatment does not suit you in any way, or if you experience unbearable side effects, the device can be completely removed with another surgery.

Are there no risks and complications with this surgery?

As with any surgery, DBS surgery can have risks and complications. Your doctor will explain these to you in detail.

Recovery time and things to be aware of

It may take several weeks to fully recover from surgery. During this time, it is very important to follow your doctor's instructions carefully.

• Rest: Avoid any strenuous activity for about two weeks after both surgeries. Do not lift anything heavier than 2.5 kilograms.
• Exercise: Avoid exercising or strenuous work for 4-6 weeks.
• Be careful: Avoid lifting your arms for a few days after the pulse generator is inserted.
• Keeping the wound clean: Keep wounds on the head and chest clean and dry. Change the dressing as directed by the doctor. Use a mild cleanser like baby shampoo when bathing. Do not scratch the wound.

When to see a doctor immediately

Since DBS is a brain surgery, you should be very aware of certain warning signs. If you experience any of the following symptoms, call your doctor immediately, or go to the Emergency Department (ETU) of your nearest hospital.

Some more common questions about DBS

Can I not use electronic devices if I have DBS?

Normally, household appliances such as microwaves, computers, and smartphones do not cause any problems. However, metal detectors at airports and anti-theft scanners in some stores may be affected by this device. The doctor will give you a special ID card to use in such cases.

Most importantly: After a DBS device is implanted, medical tests and treatments such as MRI scans, transcranial magnetic stimulation (TMS), and diathermy cannot be performed.

Does DBS completely cure the disease?

No. DBS is not a cure, it is a treatment . It is used to control symptoms. Many of the conditions treated with this treatment are lifelong.

Can I stop taking medication after DBS?

You may be able to reduce the dose of medication you take, but it is rarely possible to stop it completely. DBS treatment is most effective when used in combination with medication and other treatments.