Deep brain stimulation
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Deep brain stimulation is used in a variety of clinical settings, predominantly in patients with poorly controlled movement disorderesdisorders. Although effective its exact mode of function continues to be poorly understood 2.
Careful patient selection and target selection are essential if the procedure is to have good efficacy.
Indications
-
Parkinson disease
- subthalamic nucleus 1
- pedunculopontine nucleus
- globus pallidus (pars interna)
- severe essential tremor
- ventral intermediate nucleus 2
- dystonia (cervical dystonia and tardive dystonia) 4
- globus pallidus (pars interna)
- chronic pain 5
- thalamus
- periaqueductal grey matter
- neuropsychiatric disorders - largely experimental 4
- Tourette syndrome
- centromedian parafascicular complex (thalamus)
- medically refractive depression
- white-matter tracts adjacent to cingulate gyrus
- nucleus accumbens
- obsessive compulsive disorder
- anterior limb of internal capsule
- subthalamic nucleus
- striatum
- Tourette syndrome
Procedure
A sterotactic frame is applied and imaging obtained to enable accurate target selection. With the aid of multi-planar reformats and operative sterotaxis a burr-hole is made for each probe and the electrode passed to the desired target, avoiding the ventricles, vessels and sulci. Intraoperative stimulation is then performed to ensure adequate positioning. Leads are tunnelled under the skin and the internal pulse generator (IPG) implanted in a similar location to a pacemaker.
Complications and side effects
Complications usually occur immediately or shortly after placement, and include haemorrhage, mal-placement, and very rarely infection.
Side effects predominantly relate to the stimulation itself, which may lead to dysarthria, disequilibrium, motor disturbances and paraesthesiae. These symptoms will of course vary with the exact location of the probes.
-<p><strong>Deep brain stimulation</strong> is used in a variety of clinical settings, predominantly in patients with poorly controlled movement disorderes. Although effective its exact mode of function continues to be poorly understood <sup>2</sup>.   </p><p>Careful patient selection and target selection are essential if the procedure is to have good efficacy. </p><h4>Indications</h4><ul><li><a href="/articles/parkinson-disease" title="Parkinson disease">Parkinson disease</a><ul><li>subthalamic nucleus <sup>1</sup></li><li>pedunculopontine nucleus</li><li>globus pallidus (pars interna)</li></ul></li><li>severe essential tremor<ul><li>ventral intermediate nucleus <sup>2</sup></li></ul></li><li>dystonia (cervical dystonia and tardive dystonia) <sup>4</sup><ul><li>globus pallidus (pars interna)</li></ul></li><li>chronic pain <sup>5</sup><ul><li>thalamus</li><li>periaqueductal grey matter</li></ul></li><li>neuropsychiatric disorders - largely experimental <sup>4</sup><ul><li>Tourette syndrome<ul><li>centromedian parafascicular complex (thalamus)</li></ul></li><li>medically refractive depression<ul><li>white-matter tracts adjacent to cingulate gyrus</li><li>nucleus accumbens</li></ul></li><li>obsessive compulsive disorder<ul><li>anterior limb of internal capsule</li><li>subthalamic nucleus</li><li>striatum</li></ul></li></ul></li></ul><h4>Procedure</h4><p>A sterotactic frame is applied and imaging obtained to enable accurate target selection. With the aid of multi-planar reformats and operative sterotaxis a burr-hole is made for each probe and the electrode passed to the desired target, avoiding the ventricles, vessels and sulci. Intraoperative stimulation is then performed to ensure adequate positioning. Leads are tunnelled under the skin and the internal pulse generator (IPG) implanted in a similar location to a pacemaker. </p><h4>Complications and side effects</h4><p>Complications usually occur immediately or shortly after placement, and include haemorrhage, mal-placement, and very rarely infection. </p><p>Side effects predominantly relate to the stimulation itself, which may lead to dysarthria, disequilibrium, motor disturbances and paraesthesiae. These symptoms will of course vary with the exact location of the probes. </p>- +<p><strong>Deep brain stimulation</strong> is used in a variety of clinical settings, predominantly in patients with poorly controlled movement disorders. Although effective its exact mode of function continues to be poorly understood <sup>2</sup>. </p><p>Careful patient selection and target selection are essential if the procedure is to have good efficacy.</p><h4>Indications</h4><ul>
- +<li>
- +<a href="/articles/parkinson-disease">Parkinson disease</a><ul>
- +<li>subthalamic nucleus <sup>1</sup>
- +</li>
- +<li>pedunculopontine nucleus</li>
- +<li>globus pallidus (pars interna)</li>
- +</ul>
- +</li>
- +<li>severe essential tremor<ul><li>ventral intermediate nucleus <sup>2</sup>
- +</li></ul>
- +</li>
- +<li>dystonia (cervical dystonia and tardive dystonia) <sup>4</sup><ul><li>globus pallidus (pars interna)</li></ul>
- +</li>
- +<li>chronic pain <sup>5</sup><ul>
- +<li>thalamus</li>
- +<li>periaqueductal grey matter</li>
- +</ul>
- +</li>
- +<li>neuropsychiatric disorders - largely experimental <sup>4</sup><ul>
- +<li>Tourette syndrome<ul><li>centromedian parafascicular complex (thalamus)</li></ul>
- +</li>
- +<li>medically refractive depression<ul>
- +<li>white-matter tracts adjacent to cingulate gyrus</li>
- +<li>nucleus accumbens</li>
- +</ul>
- +</li>
- +<li>obsessive compulsive disorder<ul>
- +<li>anterior limb of internal capsule</li>
- +<li>subthalamic nucleus</li>
- +<li>striatum</li>
- +</ul>
- +</li>
- +</ul>
- +</li>
- +</ul><h4>Procedure</h4><p>A sterotactic frame is applied and imaging obtained to enable accurate target selection. With the aid of multi-planar reformats and operative sterotaxis a burr-hole is made for each probe and the electrode passed to the desired target, avoiding the ventricles, vessels and sulci. Intraoperative stimulation is then performed to ensure adequate positioning. Leads are tunnelled under the skin and the internal pulse generator (IPG) implanted in a similar location to a pacemaker.</p><h4>Complications and side effects</h4><p>Complications usually occur immediately or shortly after placement, and include haemorrhage, mal-placement, and very rarely infection.</p><p>Side effects predominantly relate to the stimulation itself, which may lead to dysarthria, disequilibrium, motor disturbances and paraesthesiae. These symptoms will of course vary with the exact location of the probes.</p>
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