Citation, DOI, disclosures and article data
Citation:
Gaillard F, Sharma R, Iqbal S, et al. Deep brain stimulation. Reference article, Radiopaedia.org (Accessed on 17 Feb 2025) https://radiopaedia.org/articles/7896
Deep brain stimulation is used in a variety of clinical settings, predominantly in patients with treatment-refractory movement disorders. 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.
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Parkinson disease
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essential tremor
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other tremor syndromes (e.g. Holmes tremor)
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dystonia syndromes (e.g. DYT1 dystonia, cervical dystonia) 4,10
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Tourette syndrome 9
thalamus: centromedian nucleus–nucleus ventrooralis internus complex, centromedian nucleus–parafascicular complex
globus pallidus internus: posteroventrolateral, anteromedial portion
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epilepsy 11,13-15
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cluster headaches 6
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chronic pain 5
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neuropsychiatric disorders: largely experimental 4
A stereotactic frame is applied and imaging obtained to enable accurate target selection. With the aid of multiplanar reformats and operative stereotaxis, a burr hole is made for each probe and the electrode passed to the desired target, avoiding the lateral ventricles, vessels and sulci. Intraoperative stimulation is then performed to ensure adequate positioning. Leads are tunneled under the skin and the internal pulse generator implanted in a similar location to a pacemaker.
Complications can be immediate or delayed 12:
Side effects predominantly relate to the stimulation itself, which may lead to dysarthria, disequilibrium, motor disturbances and paresthesia. These symptoms vary with the location of the probes.
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2. Putzke JD, Uitti RJ, Obwegeser AA et-al. Bilateral thalamic deep brain stimulation: midline tremor control. J. Neurol. Neurosurg. Psychiatr. 2005;76 (5): 684-90. doi:10.1136/jnnp.2004.041434 - Free text at pubmed - Pubmed citation
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3. Freund HJ. Long-term effects of deep brain stimulation in Parkinson's disease. Brain. 2005;128 (Pt): 2222-3. doi:10.1093/brain/awh634 - Pubmed citation
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5. Sakas DE. Operative neuromodulation, Functional neuroprosthetic surgery : an introduction. Springer Verlag. (2007) ISBN:321133078X. Read it at Google Books - Find it at Amazon
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15. Wang S, Zhao M, Li T et al. Long-Term Efficacy and Cognitive Effects of Bilateral Hippocampal Deep Brain Stimulation in Patients with Drug-Resistant Temporal Lobe Epilepsy. Neurol Sci. 2021;42(1):225-33. doi:10.1007/s10072-020-04554-8 - Pubmed
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16. Thevathasan W, Debu B, Aziz T et al. Pedunculopontine Nucleus Deep Brain Stimulation in Parkinson's Disease: A Clinical Review. Mov Disord. 2018;33(1):10-20. doi:10.1002/mds.27098 - Pubmed
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