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Deep brain stimulation (DBS) was first approved in the 1990s for the treatment of movement disorders. DBS has the potential to offer symptom resolution for a variety of disease processes. DBS involves the placement of electrodes adjacent to deep structures in the brain. These electrodes are then connected, by a wire, to a pulse generator which is subcutaneously implanted into the chest wall. The pulse generator is controlled by a computer, which ultimately gives instructions to the electrodes to fire. This activity explains the application of DBS and reviews the role of the interprofessional team in improving care for patients undergoing deep brain stimulation. Objectives: Identify the indications for deep brain stimulation. Summarize the risks associated with deep brain stimulation. Outline the targeted structures for various deep brain stimulation indications. Review the importance of collaboration and communication among the interprofessional team to ensure the appropriate selection of candidates for deep brain stimulation and to enhance postoperative management. Access free multiple choice questions on this topic.

Since the discovery of localized activation of the motor cortex in the late 19th century, electrical manipulation of the brain has frequently been the focus of scientific investigations. Following the revelation of the electrical properties of the motor cortex, subsequent mapping of cortical function was completed. This was followed in the 1950s, by the identification of deep structures of the brain via intraoperative stimulation. Theories of treating neurologic disorders with chronic stimulation began to emerge over the proceeding decade. By the 1970s, documentation of the management of pain, movement disorders, and epilepsy through the application of chronic stimulation was made evident. Eventually, in the 1990s, by combining the technologies of the implantable pacemaker with chronically implanted deep electrodes, the discovery of deep brain stimulation (DBS) was made possible.[1]

Of equal ambiguity is the side effect profile of deep brain stimulation. Whereas the surgical complications implicated with deep brain stimulation, such as hemorrhage, surgical revision of hardware, and infection, are more apparent and objective, the assessment of psychiatric and neurologic manifestations of adverse effects tend to be more discreet and protean, from patient to patient. This vagueness is multifactorial in origin. Firstly, patients may simply not relay these complaints to their respective physicians. Reciprocally, the physician, in turn, may not ask the appropriate questions in order to elucidate ongoing adverse side effects. It is plausible that even if side effects are reported, they may not be documented if they do not meet some arbitrary threshold level of severity. Moreover, it is sometimes hard to differentiate between pre-existing symptoms and comorbidities from the precipitating side effects of DBS. Furthermore, certain side effects tend to manifest over time and occur with latency. An example of this insidious onset is axial symptoms in Parkinson disease. Lastly, as science further evolves and behavioral derivatives of neurocircuitry are mapped out, it is possible that what was once celebrated as therapeutic gains from DBS treatment, will now be regarded as red flags. For example, whereas the spontaneous onset of initiative in STN-stimulated Parkinson disease patients was once applauded as progress, it is now, unfortunately, considered to be the pathological manifestation of disturbed impulse control.[17] However, current scientific literature demonstrates that deep brain stimulation is relatively safe overall and is associated with only minimal and perhaps negligible side effect profile. Nonetheless, the following includes a list of reported side effects: mild gait or speech disturbances, affective liability, worsened depression, seizure, difficulty concentrating, confusion, and headache.

The literature is abundant, with studies demonstrating the benefits of interprofessional collaboration. Patient outcomes such as decreasing morbidity and mortality rates, optimizing medication dosages, and reducing preventable adverse drug events have been shown to improve via interprofessional collaboration.[18][Level 4] Not only does this benefit the patient, but it also benefits the health care workers, by increasing job satisfaction and reducing extra work.[18] Successful deep brain stimulation (DBS) requires integrative, collaborative communication, and care. An interprofessional DBS team should include an experienced surgeon (with expertise in functional neurosurgery), a movement disorder neurologist, psychiatrist, neuropsychologist, and neuropsychologist. The nurse plays an integral role in assisting the patient gain maximum benefit from the surgical intervention. All healthcare workers must be engaged and in sync for the patient to achieve optimal results. "This research was supported (in whole or part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities."