DBS therapy is a deep brain stimulation (DBS) therapy now being administered by neurologists at the Scottsdale Mayo Clinic to treat a genetic dystonia condition that can be significantly improved by implanting electrodes into the patient’s brain and using pulse generators to stimulate certain nuclei deep in the brain to correct abnormal electrical circuits, thereby reducing These neurological symptoms can be reduced. Unlike some treatments that permanently damage the brain in a non-adjustable and irreversible way (cautery or radiotherapy), DBS does not destroy the brain structure and allows for further treatment in the future.
Indications for DBS treatment.
Diseases with clear therapeutic benefits
1.Parkinson’s disease :
(1) Clearly diagnosed, with at least two of the four major symptoms and definitely tremor or rigidity;
(2) obvious symptoms, moderate or severe Parkinson’s disease, discontinued at the time of the disease ≥ stage III;
(3) unsatisfactory results even with increased doses of Parkinson’s disease medication;
(4) There are obvious drug toxicity effects, such as the “on-off” phenomenon and the ochronosis, etc;
(5) drug side effects, can not be tolerated.
(2) Idiopathic tremor: the symptoms are obvious, the effect of drug treatment is poor, affecting work and life.
(3) Dystonic disorders: obvious symptoms, poor effect of medication, affecting work and life.
Disorders whose efficacy remains to be observed.
Obsessive-compulsive disorder
Epilepsy
Obesity
DBS contraindications.
1.Patients with severe dementia or depression and advanced disease who have no effect of drug therapy, secondary or atypical Parkinson’s syndrome;
2.Patients with severe cardiopulmonary disease and severe hypertension;
3.Patients with severe bleeding tendency;
4.Lack of knowledge about the effect and complications of DBS treatment;
Perioperative treatment.
Preoperative perioperative treatment
1.Pre-operative diagnosis and exclusion of other diseases;
2. Pre-operative scoring of Parkinson’s disease patients: the scores were assigned to the patients in the “on” and “off” states, respectively. The UPDRS (UnifiedParkinson’s Disease Rating Scale), the Schwab and England of dailyliving Scale and the Webster Functional Scale can be used for scoring. Dopamine test should be performed for patients with unclear drug effects;
3.Master the indications and contraindications for surgery;
4.Select the stimulation target and develop the surgical plan;
5.Pre-operative preparation;
(1) Familiarize yourself with the disease and complete the preoperative examination
(2) Make psychological preparation and spiritual care
(3) explain the precautions in surgery
(4) Reasonable preoperative medication
(5) Preoperative conversation
Intraoperative perioperative treatment.
1. Correctly install the stereotactic frame;
2.Obtain clear positioning images;
3.Accurate calculation of target point coordinates;
4.Choose reasonable anesthesia and body position comfortably;
5.Reasonable application of target point functional positioning;
6, implantation of stimulation stimulation, testing stimulation effect and side effects.
Postoperative perioperative treatment.
1.Closely observe the changes of consciousness, pupil, vital signs and limb activities.
2.Routinely review MRI or CT after surgery to observe the location of stimulation electrodes and exclude intracranial hemorrhage. If MRI reexamination is performed, the stimulator should be turned off.
3, Routinely apply hemostatic agents, prophylactic anti-infection and anti-seizure therapy after surgery, and continue to take preoperative anti-Parkinsonian drugs, unless the preoperative dose is too high, in principle, premature or rapid drug reduction is not advocated.
4. Pay attention to bed rest for 2 to 3 days after surgery. Pay attention to oral hygiene, prevent accidental aspiration for those who have difficulty swallowing, and turn regularly to prevent pulmonary complications. Leave a catheter in place for those who have difficulty in urinating.
5, explain the postoperative precautions 6, in the postoperative week to January to turn on the pulse generator, in vitro regulation, choose the appropriate stimulation parameters to achieve the best therapeutic effect.
6, 3 months after surgery, the drug dose and stimulation parameters are adjusted for long-term follow-up.