Deep brain stimulation

DEEP BRAIN STIMULATION(DBS)
A BRAIN PACEMAKER FOR
NEUROLOGICAL DISORDERS

PRESENTED BY:
SHIBANI PRASAD

4/6/2013

Dept. of IT,BMSPI-(2012 -13) ,DEEP BRAIN
STIMULATION- A BRAIN PACEMAKER FOR

1

CONTENTS
•
•
•
•
•
•
•
•
•
•
•
•

INTRODUCTION
COMPONENTS AND ITS SPECIFICATIONS
PLACEMENT OF THE COMPONENTS
METHODOLOGY OF SURGERY
DISEASES TREATED USING DBS
LIMITATIONS OF DBS SURGERY
FUTURE SCOPE AND ENHANCEMENT
DISCUSSIONS ON CURRENT RESEARCH
CONCLUSIONS
MANUFACTURING COMPANIES
HEALTH CENTRES IN INDIA
REFERENCES

4/6/2013


2

Introduction
What is Deep Brain Stimulation ?

• Deep Brain Stimulation(DBS) is a surgical treatment
which implants a medical device
called a Brain Pacemaker.
• DBS sends electrical impulse to
specific parts of the brain which
need to be stimulated .
Fig:1 IPG sending impulses to
the nerve cells
4/6/2013


3

Deep Brain StimulationFig : 2 (iv) Dystonia
• DBS in selected brain regions has provided effective
benefits for the diseases such as,
(i) Parkinson’s Disease
(ii) Chronic pain Fig : 2 (ii) Chronic
Pain
(iii) Tremor
(iv) Dystonia
• It is now considered the neurosurgical therapy of
choice for the movement disorders. : 2 (iii) Tremor
Fig

Fig : 2 (i) Parkinson’s
Disease

4/6/2013


4

Components of DBS
• DBS system consists of 3 parts,
(i)The IPG : is a battery-powered neurostimulator
encased in a titanium housing, which sends electrical
pulses to the brain to interfere with neural activity at
Fig : 3 (ii) LEAD[9]
the target site.
(ii)The lead: is a coiled 3 (iii) EXTENSION[9] in polyurethane
Fig : wire insulated
with four platinum iridium electrodes .
(iii)The Extension: it is an insulated wire. The lead is
connected to the IPG by the extension.
Fig : 3 (i) IPG[9]
4/6/2013


5

Block Diagram of an IPG

Fig:4 Block Diagram of an
IPG [9]

4/6/2013


6

Specifications

Fig :5 (i) IPG

(i) Implant pulse generator[9]:
• Model 37601(for PD )
• Size: 65 x 49 x 15 mm (2.6 x 1.9 x 0.6 in)
• Weight: 67 g (2.4 oz)
• Battery Type: Primary cell
• Channels: 2
(ii) Lead[9]:
• Model 3387 ( for PD)
Fig :5 (ii) Lead 3387
• Model 3391 ( for OCD )
• Firm tungsten stylet for accurate targeting and placement
• Soft, blunt tip for passage through tissue
• Burr hole ring and cap for secure anchoring

4/6/2013


7

Specifications (contd..)
(iii) Extension[9]:
• Model 7483 ( PD)
>Lengths : 40, 60, 95 cm
• Model 37086 (OCD)
>Lengths : 10 to 110 cm

4/6/2013

Fig :5(iii) Extension 7483


8

Physical Specifications Of IPG
Physical specifications[9]
Height

55 mm ( 2.2 inch )

length

60 mm ( 2.4 inch )

Case Thickness

11 mm ( 0.4 inch )

Weight

Model 37602: 45 g (1.6 oz)
Model 37603: 44 g (1.6 oz)

Volume

Model 37602: 28 cc
Model 37603: 27 cc
Primary cell

Battery type
Connector type

4/6/2013

Model 37202: Quadripolar, compatible
with 2-pronged extension
Model 37603: Octapolar, compatible with
Stretch-Coil extension

9

Therapy Specifications of IPG
Therapy specifications[9]
Longevity

4–6 years*

Amplitude

0 - 10.5 V (voltage mode)
0 - 25.5 mA (current mode)

Rate

2 - 250 Hz (voltage mode)
30 - 250 Hz (current mode)

Pulse Width

60 to 450 µs

Number of Defined Groups

1 to 4

Number of Programs per Group

1 to 2

Electrode Configuration

Up to 4 electrodes per lead defined as
anode, cathode or Off

* For typical PD patients , the device longevity depends on the programmed settings.
4/6/2013


10

Placement of the Components
• The IPG is placed subcutaneously below the clavicle
or in some cases, the abdomen.
• The Lead is placed in one of three areas of the brain
and it is connected to the IPG by the extension .
• The Extension runs from the head, down the side of
the neck, behind the ear to the IPG.
Fig :6 Placement of the
components

4/6/2013


11

Methodology of Surgery

 It involves :

• The selection of patients. DBS is not used in the
following patients,
Patients with a previous Surgical Ablation procedure
Patients who are pregnant
Patients under the age of 18 and aboveFig : 7 A patient undergoing
75.
DBS surgery
• The implantation of DBS device,
> DBS electrode placement
> DBS battery placement.

4/6/2013


12

Methodology of Surgery( contd..)
• DBS electrode placement has 2 steps:
(i) Planning step: In this step an anatomical point is
defined using high definition MRI.
(ii) Intraoperative stage :
The placement of DBS leads are
accomplished by stereotactic
apparatus.
• DBS battery placement:
> Battery is placed below the clavicle
or in some cases the abdomen.
4/6/2013


Fig : 8 A Stereotactic
apparatus[13]
13

Surgery Procedure
•
•
•
•
•
•

Step 1:Attachment of stereotactic frame.
Step 2: Take MRI or CT scan
Step 3: Skin and Skull incision
Step 4: Insert electrode in the brain
Fig : 9(iv) Step 5
Step 5. Stimulate the brain cells
Step 6: Closure Fig : 9(i) Step 1
Fig : 9(ii) Step 3

4/6/2013


Fig : 9(iii) Step 4

14

Diseases treated using DBS Parkinson’s Disease

• Symptoms : Tremor, rigidity, and postural instability.
• Sites of treatment : The Subthalamic Nucleus (STN)
and the Globus Pallidus Interna (GPI).
• Approval : It is approved by FDA.

Fig : 10(i) A patient with IPG
4/6/2013

Fig : 10(ii) Parkinson’s disease
affected brain[13]


15

Chronic Pain

• Causes : Neuropathic pain, Nociceptive pain.
• Sites of treatment : The Peria Queductal Gray and
Periventricular gray for nociceptive pain, Ventral
Posterolateral nucleus and Ventral Posteromedial
Nucleus for neuropathic pain .
• Approval : It is approved and recommended.
Fig : 11 Chronic pain existing parts of
brain[13]

4/6/2013


16

Major Depression
• Causes : Treatment resistant depression (TRD),
Obsessive compulsive disoirder (OCD)
• Sites of treatment : Ventral Capsule/Ventral
Striatum, Inferior Thalamic Peduncle and the Lateral
Habenula.
• Approval : DBS for TRD and OCD are not approved in
North America.
Fig : 12 Brain parts reason for
depression.

4/6/2013


17

Tourette Syndrome
• Causes : Inherited disorder.
• Sites of treatment : Cortical and Subcortical regions,
the Thalamus, Basal Ganglia and Frontal Cortex.
• Approval : Approved but not recommended on
children except those in severe cases.

Fig : 13(i) Tourette
syndrome affected
parts of the brain.
4/6/2013


Fig : 13(ii) Tourette syndrome
18
affected child treated with DBS

Limitations of DBS surgery

• Wound infection, postoperative headache(Fig 14(ii) )
and worsening/irritable mood and increased
suicidality.
• One of the major risks is haemorrhaging(Fig:14(i) ),
or excessive bleeding caused by damage to blood
vessels.
• It is expensive.
Fig : 14(i) Hemorrhage of
the brain.

4/6/2013


Fig :14(ii) Headache after
surgery
19

Future scope and Enhancement

• Focuses on,
 An adaptive closed loop controlled DBS(Fig:15) helps
in automatic adaptation of IPG according to the
feedback it receives[2].
 The device which automatically senses the need for
increased voltage.
 Improving longevity.
 Reduction in size.
 Reduction in cost.
Fig :15 An adaptive
closed loop
 Low risk.
[2]
controlled DBS

4/6/2013


20

Discussions on Current Research
• DBS can be eventually implemented for the sideeffects caused by PD i.e., Word fluency worsening
and also can be witnessed to help the visually
impaired[3].
• Wireless wrist-wearable (Fig :16) wake/sleep
identification device for closed-loop deep brain
stimulation[4].
Fig :16 Wireless wrist
wearable.[4]

4/6/2013


21

Existing DBS- Restoring Sight to the
blind.

• Direct brain implants have been used to treat noncongenital blindness and “ locked-in syndrome”.
• One of the first scientists to come up with a working
brain interface to restore sight was private
researcher William Dobell[11].

Fig : 17 Jens Naumann - DBS
implemented patient[11]

4/6/2013


22

DBS- Restoring Sight to the blind.
(contd..)
• Initially BCI contained 68 electrodes which were
implanted onto visual cortex.
• It produced phosphenes, which succeeded in sensing
lights.
• He was made to hooked up to a large mainframe.
* BCI- Brain Computer Interface.
Fig :18 DBS for visually
impaired

4/6/2013


23

Future enhancement in BCI
• In theory , Non-invasive BCI is under research which
can be implanted under skull rather than into the
gray matter.
• They are found to produce better resolution, less risk
of forming scar tissue.

4/6/2013


24

Eye Microchip with implanted DBS
• Scientists are developing an electronic eye implant
which they believe could help millions of people to
see again.
• The microchip works by stimulating cells around the
retina. This in turn stimulates cells in the brain,
helping people to see [7].
Fig :19 Eye Microchip with
implanted DBS.[7]

4/6/2013


25

Conclusions
• Advances in the neurosciences will continue to drive
the applications of DBS.
• Finally, innovations in biomedical engineering and
technology will continue to be applied to DBS.
• The ideal platform for the development of these
innovations is the active collaboration between basic
scientists, engineers and clinicians.
4/6/2013


26

Manufacturing companies

4/6/2013


27

Health centres in India
•
•
•
•

Kokilaben Dhirubhai Ambani Hospital, Mumbai
Apollo Hospitals, Chennai
Sterling Hospital, Ahmedabad (Fig:19)
Columbia Asia Referral Hospital, Bangalore.

Fig :20 A patient treated with DBS at
Ahmedabad hospital.[8]

4/6/2013


28

References
[1] Chima O. Oluigbo, Asem Salma, and Ali R. Rezai,” Clinial Application Review”, ieee
reviews in biomedical engineering, vol. 5, 2012.
[2] Sabato Santaniello, Member, IEEE, Giovanni Fiengo, Member, IEEE, Luigi Glielmo,
Senior Member, IEEE, and Warren M. Grill, Senior Member, IEEE,“Closed-Loop Control
of Deep Brain Stimulation:A Simulation Study”, ieee transactions on neural systems
and rehabilitation engineering, vol. 19, no. 1, february 2011 15.
[3] yuka watanabe, tubasa sada, ryotaro takashima, masatsugu takano, hiromi tateno and
koichi hirata department o/neurology dokkyo medical university 880 kitakobayashi,
mibu, shimotuga, tochigi, japan yuka-ko@dokkyomed.ac.jp,” Evaluation of the word
fluency in parkinson's disease patients treated with deep brain stimulation -a pilot
study”, proceedings of 20121cme international conference on complex medical
engineering july i - 4, kobe, japan.
[4] Y. Chen, H.W. Hao, Y.X. Hu and L.M. Li,” Wireless wrist-wearable wake/sleep
identification device for closed-loop deep brain stimulation”, Electronics letters 28th
march 2013 vol. 49 no. 7.

4/6/2013


29

References (contd..)
[5] Zitella LM, Mohsenian K, Pahwa M, Gloeckner C, Johnson
MD.,“Computational modeling of pedunculopontine nucleus deep brain
stimulation.”,Department of Biomedical Engineering, University of
Minnesota, Minneapolis, MN, USA.
[6] Jan Gimsaa, Beate Habela, Ute Schreiberb, Ursula van
Rienenb,,”Choosing electrodes for deep brain stimulation experiments–
electrochemical considerations”, Department of Biology, University of
Rostock,Germanyb University of Rostock, Faculty of Computer Science
and Electrical Engineering, Chair of Theoretical Electrotechnics,AlbertEinstein-Str. 2, D-18059 Rostock, Germany. Journal of Neuroscience
Methods 142 (2005) 251–265.

4/6/2013


30

Online References
[7]http://news.bbc.co.uk/2/hi/health/2547491.stm
[8]http://articles.timesofindia.indiatimes.com/keyword/deep-brain-stimulation
[9]http://professional.medtronic.com/pt/neuro/dbsmd/prod/dbs-extensionmodel-37086/index.htm#.UasK_tJyBZ8
[10]http://science.howstuffworks.com/life/inside-the-mind/human-brain/deepbrain-stimulation6.html
[11]http://jacobbollinger.com/?page_id=13
[12]http://www.fda.gov/Safety/Recalls/ucm350691.html

[13]http://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological
/deep_brain_stimulation_135,38/

4/6/2013


31

4/6/2013


32

4/6/2013


33

Deep brain stimulation

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Deep brain stimulation

Similar to Deep brain stimulation (20)

Recently uploaded

Recently uploaded (20)

Deep brain stimulation