The basal ganglia are brain nuclei that coordinate movement and cognitive functions. Deep brain stimulation (DBS) involves surgically implanting electrodes into the basal ganglia to deliver electrical stimulation for treating movement and neuropsychiatric disorders like Parkinson's disease. DBS was introduced in the 1990s and works by inhibiting or activating target areas in the basal ganglia to disrupt pathological oscillations. Common targets for stimulation include the subthalamic nucleus and globus pallidus. DBS improves motor symptoms in Parkinson's patients and allows for reductions in medication. Potential risks include infection, bleeding in the brain, and device-related complications.

1. DEEP BRAIN STIMULATION
By MEENAKSHY SUDEEP

2. BASAL GANGLIA ANATOMY
•The Basal ganglia are collection of nuclei
grouped based on there interconnections
•Important in coordinating movement and in
cognitive function
•work in concert with the pyramidal motor
pathway

3. COMPONENTS OF BASAL GANGLIA
• CORPUSTRAITUM
• Straitum ---- caudate nucleus and putamen
• Pallidum ---- globus pallidus
• SUBSTANTIA NIGRA
• pars compacta
• Pars reticulate
• SUBTHALAMIC NUCLEUS
• AMYGDALA
• CLAUSTRUM

4. BASAL GANGLIA AND PATHWAYS

5. ROLE OF BASAL GANGLIA
• Motor and cognitive functions
• Controlling eye movements
• Role in motivation
• Decision making
• Working memory

6. CLINICAL SIGNIFICANCE
• Hyperkinetic and hypokinetic disorders
• Mainly movement disorders
• Common disorders associated with basalganglia dysfunctions are
chorea, wilsons disease, touretts syndrome, pd, kernictures, pap
syndrome etc,..
• In Parkinson disease the degeneration of dopaminergic neurons of
the substantia nigra pars compacta triggers a cascade of functional
changes affecting the whole basal ganglia network

7. DEEP BRAIN STIMULATION
• Inroduced in the 1990s
• By Benavides ET AL
• neurosurgical procedure involving the implantation of a medical
device called a neurostimulator
• sends electrical impulses, through implanted electrodes, to specific
targets in the brain (brain nuclei) for the treatment of movement and
neuropsychiatric disorders

8. MECHANISM OF DBS
• Proposed mechanism of DBS can be grouped into 4 main catagories
1. INHIBITION OF TARGET
2. ACTIVATION OF TARGET
3. COMBINED INHIBITION AND ACTIVATION
4. DISRUPTION OF PATHOLOGICAL OSCILLATION TO RESTORE RHYTHMIC
ACTIVITY AND SYNCHRONISATION
• It involves decoupling of axonal and neuronal transport in bg that
takes place in corticospinopallidothalamic tract

9. DBS-probes shown in X-ray of the skull

10. Components of DBS
• The LEAD or electrode : a thin, insulated wire—is inserted
through a small opening in the skull and implanted in the
brain. The tip of the electrode is positioned within the
targeted brain area
• The EXTENSION : Is an insulated wire that is passed under
the skin of the head, neck, and shoulder, connecting the lead
to the neuro stimulator
• The NEUROSTIMULTOR : is the third component and is
usually implanted under the skin near the collarbone

12. TARGET SITES FOR STIMULATION
• SUBTHALAMIC NUCLEUS
• GLOBUS PALLIDUS INTERNA
• THALAMUS

13. PATIENT SELECTION FOR DBS
• The best candidates for DBS therapy will meet most of the following
criteria:
• Patient have PD symptoms for 5 years
• On/off fluctuations with or without dyskinesia
• If pd symptoms interfere with daily activities
• continue to have a good response to PD medications, especially carbidopa/
levodopa

14. TECHNIQUE OF DBS
• The procedure is used only for patients whose symptoms cannot be
adequately controlled with medication
• Surgical implanatation
• Targeted area is located by ct or mri imaging
• Quadripolar leads are connected to stimulator and to battery
• Once electrodes are implanted it is attached top wires that run inside body
from head down to collar bone where battery operated stimulator are
implanted
• From stimulator electrical impulses are continuously delivered over wire to
electrode in brain
• Reprograming can be done with 3,4 months

15. DBS SURGERY

16. POST SURGERY PATIENT CARE
• Complications can develop during the first few weeks or even months
after surgery. Patient should be aware the signs and symptoms of
infection
• precautions that you can take to prevent an infection include the
following
• Never scratch, touch, or put any pressure on the incision
• Be sure pillows, sheets, and bedding are clean
• Keep the stitches clean and dry
• Return to have sutures or staples removed at the schedule time
• Look for sign of infection

17. SIDE EFFECTS and RISK
• Headache, nausea and vomiting
• Pain, inflammation and swelling at surgical site
• Confusion
• Numbness and weakness of body
• Difficulty in speech
• Mood changes
• Bleeding in brain
• Movement disorders etc…

18. COMPLICATION OF DBS SURGERY
• Hardware related complications
• Lead migration
• Lead fracture
• Lead erosion
• Lead malfunction
• Malfunctioning of neurostimulator
• Seizures
• Dystonis
• Hemorraghe etc….

19. ADVANTAGE OF DBS IN PARKINSON DISEASE
• DBS is not a cure for PD
• It is a treatment that helps relieve the motor symptoms of PD, as well
as some of the non-motor symptoms It is called a symptomatic
therapy
• Bilateral DBS is often required to improve gait, although sometimes
unilateral DBS has a marked effect on walking
• Smooths out on/off fluctuations
• Improves tremor, stiffness (rigidity), bradykinesia, and dyskinesia
• Decreases medications

20. DBS site Effect of therapy
• Thalamus (Vim) Reduces tremor but not the other of PD
• Globus pallidus (GPi): Reduces tremor, rigidity, bradykinesia, gait
problems, dyskinesia
• Subthalamic nucleus (STN): Reduces tremor, rigidity, bradykinesia,
gait problems, dyskinesia

21. INDICATION OF DBS
• Parkinson disease
• Essential tremor
• Dystonia
• Epilepsy
• Tournette syndrome
• Ocd
• Chronic pain

22. Advantages of DBS
• Reversibility
• Adjustability
• imp[rove quality of life
• Help to reduce medications
• Relatively safe procedure
• Improves energy level

23. Disadavantages
•Highly expensive
•Increased risk of infection due to
implantation of foreign object

24. Bibliography
• Guide_to_DBS_Stimulation_Therapy
• Parkinson.org