Brain pacemaker is the colloquial term for deep brain stimulation (DBS). This neurosurgical intervention in the brain is used to treat Parkinson's disease, dystonia (cramps, tremor), epilepsy or Tourette's syndrome. Alongside strokes and dementia, Parkinson's disease is one of the most common diseases of the nervous system in older people.
Here you will find further information as well as selected brain pacemaker specialists and centers.
A brain pacemaker is a technical device used in neurosurgery. Surgeons implant electrodes into the patient's brain, which are connected to a pulse generator. This is located in the chest area and sends electrical impulses to the brain at regular intervals.
Depending on the set current frequency, the affected region in the brain is stimulated or deactivated.
The brain pacemaker is reversible, meaning it can be removed again. The brain pacemaker was first approved in the EU in 1995 for the treatment of essential tremor. Tremor is a disorder characterized by muscle tremors with no known cause. This was followed in 1998 by approval for treatment of Parkinson's disease.
Several diseases are now being treated:
Studies are also underway on the use of deep brain stimulation in patients suffering from
depression.
Electrodes and extensions are surgically inserted into the skull and connected to a neurostimulator under the collarbone © RFBSIP | AdobeStock
The main target group for the brain pacemaker are Parkinson's patients over the age of 60 who have suffered from the disease for many years. If the prescribed medication no longer works or the patient is struggling with severe side effects, an operation may be considered.
Studies by German and French neurologists show that the procedure can also be useful for younger people. A brain pacemaker is particularly helpful for younger people with
Patients who have only recently been affected can also benefit from a brain pacemaker.
Study participants reported
The use of medication was also significantly reduced.
The brain pacemaker essentially consists of three parts:
One or more electrodes can be implanted. These are thin cables that are placed by the neurosurgeon in the target region of the brain with millimeter precision.
The extensions also consist of a thin cable and connect the electrodes to the neurostimulator. They run under the skin and lead from the head via the neck to the chest area.
The neurostimulator is usually located under the collarbone. The device contains electronic circuits and a battery. The neurostimulator is the actual brain pacemaker and generates electrical impulses that reach the electrode via the extension.
The settings are made using a programming device, which the doctor can use to make external adjustments. The patient usually also receives a small device. This allows the patient to switch the neurostimulator on and off or adjust the stimulation within the limits approved by the doctor.
The full details of how the brain pacemaker works have not yet been clarified, although various theories are being discussed.
The reduction of movement disorders in the incurable disease Parkinson's is the most important purpose of the brain pacemaker. In Parkinson's disease, atrophied nerve cells in the brain can no longer produce enough of the neurotransmitter dopamine. This results in typical symptoms such as
which are usually kept in check by medication. However, after years of use, the effectiveness of the medication decreases.
As a result, phases of poor and good mobility (fluctuations) alternate. Patients do not know when and to what extent the symptoms will return. They then often begin to leave the house less frequently and suffer increasingly from the disease.
A brain pacemaker can be the solution at this stage of the disease. Deep brain stimulation stimulates the basal ganglia (regions of the brain that are important for movement). This significantly reduces the symptoms.
Studies show that the electrical impulses reduce symptoms in up to 80 percent of cases. This leads to significantly improved mobility:
The implantation of a brain pacemaker takes place in two steps.
First, the electrodes are placed under partial anesthesia. The neurosurgeon drills small holes in the skull and inserts the electrodes. To ensure optimal positioning, magnetic resonance imaging (MRI) and/or computer tomography (CT) is performed at the same time.
During this phase, the patient is usually fully conscious. This allows the patient to provide the surgeon with informative feedback on the physical effects of the placement of the electrodes.
The second stage of implantation takes place immediately afterwards or on the following day. Under general anesthesia, the surgeon then implants the extension and the neurostimulator.
The basic settings of the pacemaker are made during the operation. The fine adjustments are made jointly by the doctor and the patient in the following weeks.
Depending on the model, the batteries in the neurostimulator can last up to seven years. They are later replaced under local anesthesia.
Deep brain stimulation is not without controversy, as it does involve some risks. The procedure can lead to vascular injury and bleeding. This in turn can cause paralysis or speech disorders. There is also a risk of epilepsy or inflammation of the brain or meninges.
It is also possible for the electrodes to slip out of place or be misplaced, making further surgery necessary.
Side effects are also caused by the electrodes. Depending on the position, speech, visual or sensory disturbances may occur. Patients also report
For these reasons, it is important that the procedure is carried out by an absolute specialist.
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