Introduction
Deep Brain Stimulation (DBS) is an advanced neurosurgical procedure that involves implanting electrodes in specific areas of the brain. These electrodes produce electrical impulses that regulate abnormal impulses or affect certain cells and chemicals within the brain. The amount of stimulation is controlled by a pacemaker-like device placed under the skin in the upper chest, connected to the electrodes by a wire traveling under the skin. DBS is primarily used to treat movement disorders such as Parkinson’s disease, essential tremor, and dystonia, particularly when medications are no longer effective or cause severe side effects. It can significantly reduce symptoms like tremors, rigidity, and bradykinesia (slowness of movement), improving the patient’s mobility and quality of life.

Surgical Procedure
The DBS procedure is usually performed in two stages.
Stage 1 (Brain Surgery): The patient is typically awake but sedated during this part to help the surgeon verify the correct placement of the electrodes. A stereotactic head frame is attached to the patient’s skull to keep it perfectly still. Using MRI or CT mapping, the surgeon drills a small hole in the skull. A thin wire (electrode) is carefully guided into the targeted brain area. The patient may be asked to perform simple tasks (like moving fingers or counting) while test stimulation is applied to ensure the electrode is in the right spot and minimizing side effects.
Stage 2 (Chest Surgery): This is performed under general anesthesia a few days to weeks later. The surgeon implants the neurostimulator (battery pack) under the skin of the chest, near the collarbone. An extension wire is passed under the skin of the head, neck, and shoulder to connect the brain electrodes to the neurostimulator.

Surgical Risks
As a brain surgery, DBS carries inherent risks, including bleeding, infection, and adverse reactions to anesthesia.

General Complications
Common, mostly temporary complications include:
– Pain, swelling, and soreness at the incision sites (head and chest).
– Temporary tingling in the face or limbs.
– Mild confusion or mood changes immediately following the surgery.
– Headache.

Rare but Serious Complications
Serious complications are rare but can include:
– Brain hemorrhage (bleeding in the brain) or stroke, which can lead to permanent neurological deficits.
– Infection of the brain, the incisions, or the implanted hardware, which may require removing the device.
– Seizures.
– Hardware complications, such as wire breakage, device malfunction, or the stimulator shifting under the skin.
– Stimulation-related side effects, such as speech problems, balance issues, or muscle tightness, which can often be resolved by adjusting the device’s programming.

Pre-operative Preparation
– Comprehensive Evaluation: Extensive neurological, psychological, and physical assessments are required to determine if the patient is a suitable candidate.
– Imaging: High-resolution MRI and CT scans are used to map the brain targets.
– Medication Adjustments: Parkinson’s medications may need to be stopped or adjusted on the morning of the brain surgery so symptoms are visible for accurate electrode placement.
– Fasting: Required before both stages of the surgery.

Post-operative Care
After Stage 1, patients typically stay in the hospital for 1 to 2 days. Stage 2 is often an outpatient procedure. The neurostimulator is usually not turned on until 2 to 4 weeks after the second surgery, allowing the brain swelling to subside. Programming the device is a gradual process that requires multiple outpatient visits to find the optimal settings.

Wound Care
– Keep incisions on the head and chest clean and dry.
– Avoid washing hair for a few days after the brain surgery, as directed by the surgeon.
– Watch for signs of infection (redness, swelling, warmth, pus) at all incision sites.

Diet
No specific dietary restrictions apply, but a balanced diet aids in recovery.

Post-discharge Notes
– Avoid strenuous activities, heavy lifting, and raising the arms above the shoulders for a few weeks to allow the chest incision to heal and prevent the wires from pulling.
– Avoid strong magnetic fields, such as MRI machines (unless the DBS system is explicitly MRI-compatible) and metal detectors.
– Carry a DBS identification card at all times.
– Attend all follow-up appointments for device programming and battery checks (batteries last 3 to 5 years, or longer for rechargeable models).