Brain stimulation surgery for involuntary movements in Jordan
الجراحة لعلاج الحركات اللاإرادية عن طريق زرع بطارية بالدماغ
Deep brain stimulation, often described by patients as implanting a battery in the brain, places one or two fine electrodes in a specific deep brain nucleus and connects them to a small pulse generator implanted under the skin of the chest below the collarbone. The generator delivers precisely controlled electrical pulses that modulate the activity of the circuits responsible for tremor, rigidity and involuntary movements. It is usually considered for people with Parkinson's disease whose response to medication has become unpredictable through the day or who have developed troublesome involuntary movements, for people with essential tremor severe enough to disable writing, eating and work, and for selected cases of dystonia. It modifies symptoms; it is not directed at the cause of the disease. Candidacy is decided by a multidisciplinary team rather than a single doctor: a movement-disorder neurologist, a neurosurgeon, a neuropsychologist, an anaesthetist and a neuroradiologist. Assessment includes testing how far the symptoms respond to medication, detailed brain imaging, and evaluation of cognition, memory and mood. The final decision rests on clinical examination and the results of that assessment, not on reading a web page. The limits must be stated plainly. Stimulation does not cure Parkinson's disease and does not halt its progression. It relieves the symptoms that already respond to medication, with the exception of tremor, which may improve even when it does not respond to drugs. Its effect on balance, freezing of gait, swallowing and quiet speech is limited, and some of these can worsen in certain patients. It does not improve memory or thinking, and people with clear cognitive decline or unstable psychiatric illness are usually not considered. Medication is not stopped after surgery; it is adjusted gradually and only under the supervision of the treating neurologist. It is also important to know that the device is usually not switched on the day of surgery. Programming begins weeks later and needs repeated sessions over months to reach the best settings. Always carry the device card and tell any doctor, dentist or imaging technician about the implant before any electrical procedure or MRI scan.
Procedure steps
- 1
Assessment and multidisciplinary selection
The pattern of symptoms and how far they disable daily life are documented, their response to medication is measured, cognition, memory and mood are formally assessed, and imaging and other illnesses are reviewed. The team then decides jointly whether the patient is a candidate and which brain target suits the symptoms.
- 2
Imaging and stereotactic target planning
MRI is fused with fine-slice CT to build a three-dimensional map, the target and the trajectory towards it are chosen to avoid blood vessels, ventricles and functional areas, and the coordinates are calculated to millimetre accuracy before entering theatre.
- 3
Electrode implantation with position verification
The head is fixed, a small hole is made in the skull and the electrode is advanced to the target. The patient may be kept awake for part of the operation so that improvement in tremor or rigidity and the absence of unwanted effects can be checked, or verification may rely on recordings and imaging while asleep.
- 4
Implanting and connecting the pulse generator
The pulse generator is implanted under the skin of the chest below the collarbone and connected to the electrodes by an extension tunnelled under the skin of the neck. The wounds are closed and the integrity of the connections is checked electrically before the operation ends.
- 5
Programming and titration over weeks
Stimulation is usually started weeks after surgery, and its intensity, frequency and active contacts are adjusted over successive sessions while medication is modified gradually by the neurologist. Reaching the best combination takes months rather than a single visit.
Before the procedure
Attend every pre-decision assessment: neuropsychological testing, the medication response test and the imaging appointments. Tell the team about all your medicines, particularly blood thinners and anticoagulants, and do not stop them on your own. Report any heart or lung disease, any skin infection, and any implanted device such as a cardiac pacemaker. Treat dental and skin infections before the date, as they raise the risk of device infection. Ask which part of the operation you may be awake for and what simple movements you will be asked to perform; knowing this in advance greatly reduces anxiety. Shave your head only as the team instructs, and follow the fasting time. Arrange someone to accompany you and to bring you to the later programming sessions, which are repeated.
After the procedure
Keep the head and chest wounds clean and dry, and avoid forceful overhead arm movements or stretching the device area during the first weeks. Do not adjust the device settings yourself, and never reduce or stop your medication except on the neurologist's decision. Always carry the device card, tell any doctor, dentist or imaging technician about the implant before electrical surgery or MRI, and ask for a hand search at airport security. Expect the tuning to take months and your symptoms to shift gradually. **Seek emergency care immediately** for fever, redness, discharge or swelling at any wound; for **skin erosion over the device or an exposed lead**; for a **sudden severe return of tremor or rigidity**, which may mean a depleted battery or a broken connection; for severe sustained muscle spasm; for new one-sided weakness, marked slurring or confusion; for a seizure; for severe headache with vomiting and drowsiness; or for **abrupt mood change or thoughts of self-harm**, which must be reported to the team at once and never postponed.
Expected duration
Usually three to six hours, sometimes split into two stages, with a typical stay of two to four days and programming starting weeks later.
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