When drugs don’t work or lose their efficacy, DBS is a possibility. Since Parkinson’s disease treatments gradually lose their efficacy over time, your doctor will need to increase your dosage. Other negative impacts result from that. Your symptoms are under control with fewer side effects thanks to DBS, which frequently makes lower drug dosages effective once again.
As more illnesses become resistant to therapy, deep brain stimulation (DBS) surgery is becoming more common. Despite the procedure’s effectiveness, the general public is nevertheless wary of its alleged hazards.
The Risks Of DBS Surgery Can Be Divided Into 3 Categories
- Hardware Complications
- Surgical complications
- Side effects of DBS
Hardware Complications
As S such deep brain stimulation is considered to be a safe procedure. However, the skill and expertise of performing this surgery is extremely essential. The common hardware complications that have been reported include the following:
- Infection of the hardware
- Fracture of the electrode or the connecting wire
- Erosion of skin over the pacemaker
- Displacement of the electrode
All these complications are relatively infrequent and range from 2 to 5% in various large reported series. It has also been shown that proper training and handling of the hardware minimises the risk of these complications [i]. Most of the time when these complications occur, they can be treated conservatively which antibiotics. However, in some instances, the hardware must be removed from the patient to control the infection. In case of a fracture of the hardware, the impedance of the electrode will rise and this will alert the physician to take necessary action. Mostly the electrode or the connector would have to be replaced.
Surgical Complications
These are complications related to the surgical procedure. Once again this can be minimised by gaining more and more experience and meticulous planning of the surgery.i The following are the complications that can be attributed to surgical complications:
- Haemorrhage
- Confusion
- Aspiration and chest infection
- Seizure
The most fearful complication of deep brain stimulation surgery is haemorrhage. Once again the number of haemorrhage cases were reduced to nil, in one of the series published recently, with gaining of experience. It is believed that an experience of >200 deep brain stimulation surgeries is essential to minimise the risk of these complications.
Side Effects Of Stimulation
Just like any medical treatment, even the surgical therapy of DBS has side effects. Whenever we take a new tablet it is usually associated with some kind of side effects like nausea, vomiting or burning of the stomach. Similarly, following DBS there is a possibility of the current spread to important areas of the brain leading to some side effects. These side effects range from minor side effects like speech difficulty, walking difficulty, depression or other behavioural functions. As the deep brain stimulation surgery is completely reversible, one can reduce the amount of stimulation by reducing the current and avoid this side effect. Sometimes it is difficult to avoid this side effect and the clinician’s expertise is required to choose the alternative contact point on the electrode to get rid of this side effect. This particular exercise is called deep brain stimulation programming. Once again surgical expertise and programming expertise come to help in reducing these side effects
It is crucial to speak with your doctor and follow aquatic safety procedures before swimming because there have been sporadic reports that DBS therapy affects the movements required for swimming.
What Are The Factors That Increase The Risk Of Adverse Events?
For further risk classification and the identification of individuals who might need closer follow-up in the postoperative phase, a preoperative assessment by a neuropsychiatrist and neuropsychologist is also required. Mild cognitive impairment and behavioural or mood disorders are common in PD patients and should be recognized and treated. While more severe or progressive changes may be risk factors for additional worsening brought on by the surgical process and/or stimulation, stable and lesser versions of these abnormalities generally do not always signal that surgery is contraindicated.
Although there are no set age restrictions for DBS surgery, early clinical trials tended to include patients between the ages of 50 and 65. This could be an indication of a widespread worry among neurologists and neurosurgeons referring patients about severe surgical complications, the body’s capacity to recover, and the rapid development of motor symptoms in elderly patients.
Prior to performing any elective brain surgery, patient-specific medical problems must be taken into account. Prior to any scheduled surgical intervention, patients who are more likely to experience perioperative problems should have their medical condition optimized. A cardiologist should first assess patients with a history of angina or coronary vascular disease. Prior to surgery, patients who are receiving antiplatelet drugs for heart disease or anticoagulants for atrial fibrillation, pulmonary emboli, or deep vein thrombosis must temporarily stop taking these medications or should be appropriately bridged with a reversible prescription. To avoid complications during and after surgery, comorbid illnesses like diabetes and hypertension should be properly managed. When risk stratifying a patient for consideration of surgery, consideration should also be given to the patient’s age and general physical condition. Younger people may benefit more from and endure DBS surgery better even if there is no upper age limit for consideration. Patients who are very old or who have severe dementia might not be excellent candidates for DBS surgery.
Managing expectations is one of the most crucial elements in achieving satisfying results for PD patients following DBS. The patient’s most incapacitating symptoms should be noted, and postoperative expectations should be evaluated. It is imperative to clarify what the most likely results of surgery are. This includes a straightforward description of which symptoms are likely to get better, how much better they will get, and which symptoms might not get better or might even get worse after surgery. Patients may be dissatisfied with their postoperative status if there is a mismatch between expectations and surgical outcomes.
References:
- https://pubmed.ncbi.nlm.nih.gov/24236657/
- https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562#:~:text=Surgery%20risks,Bleeding%20in%20the%20brain
- https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation#risks–benefits
- https://www.ncbi.nlm.nih.gov/books/NBK536714/
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