Deep brain stimulation, or DBS, is a therapy that uses a surgically implanted device to deliver electrical signals to specific areas of the brain. This neurostimulation is used to help manage the symptoms of certain neurological conditions. The Abbott Enspire DBS system is one of the advanced technologies available for this type of therapy, designed to regulate the abnormal nerve signals that cause motor symptoms.
Understanding the Enspire DBS System
The Enspire DBS system is composed of several integrated components that work together to deliver controlled electrical stimulation. At its core is the implantable pulse generator (IPG), a small, battery-powered device surgically placed under the skin, usually just below the collarbone. This neurostimulator is responsible for creating the electrical pulses that are sent to the brain, functioning much like a pacemaker for the brain.
Connected to the IPG are thin, insulated wires called leads. These leads are carefully guided to precise locations within the brain. At the tip of each lead are electrodes that deliver the electrical pulses to the targeted brain tissue. Some modern systems use directional leads, which allow clinicians to steer the electrical current with greater precision. This capability helps to focus the stimulation on the intended area, which can enhance therapeutic effects while minimizing potential side effects.
To manage the therapy, patients use a handheld patient controller. This device communicates wirelessly with the implanted neurostimulator. It allows the individual to turn the stimulation on or off, check the battery status of the IPG, and in some cases, switch between different stimulation programs that have been preset by their doctor.
The Implantation Procedure
The process of implanting a DBS system is performed in two distinct stages. The first stage involves the precise placement of the leads into the brain. To ensure accuracy, surgeons use advanced imaging techniques, such as MRI and CT scans, to create a detailed map of the brain. This mapping helps pinpoint the exact targets for stimulation.
During this initial surgery, small holes are made in the skull to allow for the insertion of the leads. The patient may be awake for parts of the procedure to provide feedback that helps the surgical team confirm the correct placement of the electrodes. This real-time confirmation is important for achieving the best possible symptom control.
The second stage of the procedure involves implanting the neurostimulator (IPG), which is done under general anesthesia. The surgeon places the IPG in a small pocket created under the skin of the chest. The leads that were previously placed in the brain are then connected to the IPG via an extension wire that is tunneled under the skin.
Life After DBS Implantation
Living with a DBS system involves an initial adjustment period followed by long-term management in partnership with a medical team. A few weeks after the implantation surgery, the device is turned on and programmed by a clinician. This initial programming session is the first of several appointments required to fine-tune the stimulation settings to achieve the best symptom control with the fewest side effects. This process is highly individualized and may take some time to optimize.
The system’s battery life varies depending on whether a rechargeable or non-rechargeable model is used. Patients with rechargeable devices will need to charge their neurostimulator regularly, a process that can be done at home. The Enspire DBS system is MR Conditional, which means patients can have certain types of MRI scans under specific conditions, a feature that provides flexibility for future medical imaging needs.
Regular follow-up appointments are necessary to monitor the device’s effectiveness, make programming adjustments as needed, and check the battery status. This helps to plan for eventual replacement if a non-rechargeable model was implanted.
Determining Candidacy for Therapy
The Enspire DBS system is approved for treating symptoms of conditions such as Parkinson’s disease and Essential Tremor. Candidacy for this therapy is determined through a comprehensive evaluation by a multidisciplinary medical team, which includes a neurologist, neurosurgeon, and other specialists. An ideal candidate is often someone whose symptoms are no longer adequately controlled by medications or who experiences significant side effects from their medication regimen.
The evaluation process is thorough, designed to ensure that DBS is an appropriate option for the individual. It is important for potential candidates to understand that DBS is a treatment aimed at managing symptoms and improving quality of life; it is not a cure for the underlying neurological condition. The decision to proceed with the therapy is a collaborative one, made between the patient and their medical team after careful consideration of the potential benefits and risks.