Academy

Deep Brain Stimulation (DBS)

Overview: Deep brain stimulation (DBS) is a neurosurgical therapy for movement disorders such as Parkinson’s disease. It involves surgically implanting electrodes into specific brain regions—most commonly the subthalamic nucleus (STN) or globus pallidus interna (GPi). These electrodes are connected via insulated wires to an implanted neurostimulator (pulse generator) placed under the skin, usually near the clavicle. Electrical pulses delivered at high frequency (typically 60–185 Hz) modulate pathological neural activity, alleviating motor symptoms including tremor, rigidity and bradykinesia.

Key Components:

• Electrodes: Four‐contact leads positioned stereotactically into the targeted brain nucleus.
• Neurostimulator: Implantable pulse generator delivering programmable stimulation amplitude, pulse width and frequency.
• Extensions and Connectors: Insulated extension cables route signals from electrodes to the neurostimulator beneath the skin.
• Programming System: External clinician programmer or patient controller adjusts stimulation parameters as needed.

Mechanism of Action: DBS delivers continuous or adaptive electrical pulses to disrupt pathological oscillatory activity and abnormal firing patterns. High‐frequency stimulation (>130 Hz) overrides disease‐related beta oscillations in the STN, enhancing motor circuit throughput from the motor cortex to basal ganglia output. Adaptive DBS further refines this by sensing local field potentials (LFPs) and adjusting stimulation in real time, improving efficacy and reducing unwanted side effects.

Clinical Applications:

• Parkinson’s Disease: Reduces tremor, rigidity, bradykinesia and motor fluctuations when medication response wanes.
• Dystonia: Improves muscle spasms and abnormal posturing in primary and secondary dystonia.
• Essential Tremor: Alleviates debilitating tremors unresponsive to pharmacotherapy.
• Emerging Uses: Investigational trials in epilepsy, depression and obsessive‐compulsive disorder.

Patient Experience: Preoperative imaging and microelectrode recordings guide precise electrode placement. After a healing period, stimulation is activated and titrated over several visits. Patients may use wearable sensors and diaries to track symptom changes. Adaptive systems like Medtronic’s Percept PC with BrainSense Timeline enable chronic LFP sensing for personalized DBS programming.

Future Directions: Integration of machine learning and AI will enhance adaptive DBS by identifying patient‐specific neuronal fingerprints—distinctive neural signatures linked to symptom severity. This promises more precise, energy‐efficient, and side‐effect-minimizing therapy, ultimately improving quality of life for people with movement disorders.