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Deep brain stimulation
🧠 Deep Brain Stimulation (DBS) primarily treats levodopa-responsive symptoms and can offer sustained benefits for many years. It is now a widely accepted surgical intervention for movement disorders and select neurological conditions.
📖 About DBS
- Surgical treatment of PD began in the 1940s with ablative procedures (thalamus, GPi).
- Interest waned after the introduction of levodopa but resurged in the 1990s.
- DBS replaced ablation due to fewer adverse effects and reversibility.
- Subthalamic nucleus (STN) is the commonest DBS target today.
- Best suited for patients with severe motor complications despite optimal medical therapy.
🎯 Indications
- Parkinson's Disease
- Thalamic DBS → disabling tremor.
- STN / GPi DBS → motor fluctuations, dyskinesia.
- Most effective for levodopa-responsive symptoms.
- Essential Tremor
- Unilateral VIM thalamic DBS suppresses tremor.
- Used when tremor impairs daily function and meds fail.
- Dystonia
- GPi / STN DBS for chronic, intractable primary dystonia (generalised, segmental, cervical).
- Licensed for age ≥7 years.
- Obsessive-Compulsive Disorder (OCD)
- Bilateral anterior limb of internal capsule (AIC) DBS.
- Indicated if treatment-resistant after ≥3 SSRI trials.
- Epilepsy
- Bilateral anterior nucleus of thalamus (ANT) DBS.
- Reduces seizures in refractory partial-onset epilepsy.
🧲 MRI Safety
- ⚠️ Always consult neurosurgery before MRI in patients with DBS implants.
🚫 Contraindications
- Severe cognitive impairment or psychiatric illness → poorer outcomes and risk of deterioration.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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