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Deep brain stimulation
🧠 Deep Brain Stimulation (DBS) primarily treats levodopa-responsive symptoms and can offer sustained benefits for many years. It is now a widely accepted surgical intervention for movement disorders and select neurological conditions.
📖 About DBS
- Surgical treatment of PD began in the 1940s with ablative procedures (thalamus, GPi).
- Interest waned after the introduction of levodopa but resurged in the 1990s.
- DBS replaced ablation due to fewer adverse effects and reversibility.
- Subthalamic nucleus (STN) is the commonest DBS target today.
- Best suited for patients with severe motor complications despite optimal medical therapy.
🎯 Indications
- Parkinson's Disease
- Thalamic DBS → disabling tremor.
- STN / GPi DBS → motor fluctuations, dyskinesia.
- Most effective for levodopa-responsive symptoms.
- Essential Tremor
- Unilateral VIM thalamic DBS suppresses tremor.
- Used when tremor impairs daily function and meds fail.
- Dystonia
- GPi / STN DBS for chronic, intractable primary dystonia (generalised, segmental, cervical).
- Licensed for age ≥7 years.
- Obsessive-Compulsive Disorder (OCD)
- Bilateral anterior limb of internal capsule (AIC) DBS.
- Indicated if treatment-resistant after ≥3 SSRI trials.
- Epilepsy
- Bilateral anterior nucleus of thalamus (ANT) DBS.
- Reduces seizures in refractory partial-onset epilepsy.
🧲 MRI Safety
- ⚠️ Always consult neurosurgery before MRI in patients with DBS implants.
🚫 Contraindications
- Severe cognitive impairment or psychiatric illness → poorer outcomes and risk of deterioration.
📚 References
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