Editing Deep brain stimulation (section)

== Device components ==
[[File:Prep for Deep Brain Stimulation.png|thumb|260px|An adult male undergoing pre-operative preparation for deep brain stimulation]]
The DBS system consists of three components: a neurostimulator known as an implanted pulse generator (IPG), its leads and an extension. The neurostimulator has [[titanium]] housing and a battery that sends electrical pulses to the brain to interfere with [[neural]] [[action potential|activity]] through [[afferent nerve|deafferentation]].

The leads are two coiled wires insulated in [[polyurethane]] with four [[platinum-iridium alloy|platinum-iridium]] electrodes that allow delivery of electric charge from the battery pack implanted in the chest wall. The battery is usually situated subcutaneously below the [[clavicle]] and rarely in the [[Human abdomen|abdomen]]. The leads, in turn, are connected to the battery by an insulated extension wire which travels from the chest wall [[superior (anatomy)|superiorly]] along the back of the neck below the skin, behind the ear, and finally enters the skull through a surgically made [[burr hole]] to terminate in the deep nuclei of the brain.<ref name="NINDS">{{cite web |title=Deep Brain Stimulation for Movement Disorders |url=https://www.ninds.nih.gov/health-information/disorders/deep-brain-stimulation-movement-disorders |website=National Institute on Neurological Disorders and Stroke }}</ref> Microelectrodes (usually 1–5) are delivered through the burr holes. A combination of microelectrode recordings, microstimulation, macrostimulation, and neurophysiological mapping at the level of single neurons or local neuronal populations through local field potential analyses are used to increase specificity of placement for the most precise neurophysiologic effect possible.<ref name="Lozano 2017"/>

After surgery, battery dosage is titrated to individual symptoms, a process which requires repeat visits to a clinician for readjustment.<ref name="Volkmann">{{cite journal | vauthors = Volkmann J, Herzog J, Kopper F, Deuschl G | title = Introduction to the programming of deep brain stimulators | journal = Movement Disorders | volume = 17 | issue = Suppl 3 | pages = S181–S187 | year = 2002 | pmid = 11948775 | doi = 10.1002/mds.10162 | s2cid = 21988668 }}</ref>

DBS leads are placed in the brain according to the specific symptoms to be addresses and implantation may take place under local or general anesthesia. A hole about 14&nbsp;mm in diameter is drilled in the skull and the probe electrode is inserted [[Stereotactic surgery|stereotactically]], using either frame-based or frameless stereotaxis.<ref>{{cite journal | vauthors = Owen CM, Linskey ME | title = Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle | journal = Journal of Neuro-Oncology | volume = 93 | issue = 1 | pages = 139–149 | date = May 2009 | pmid = 19430891 | doi = 10.1007/s11060-009-9871-y | doi-access = free }}</ref> During the awake procedure with local anesthesia, feedback from the individual is used to determine the optimal placement of the permanent electrode. During the asleep procedure, intraoperative MRI is used to image the brain during device placement.<ref>{{cite journal | vauthors = Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS | title = Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy | journal = Journal of Neurosurgery | volume = 112 | issue = 3 | pages = 479–490 | date = March 2010 | pmid = 19681683 | pmc = 2866526 | doi = 10.3171/2009.6.JNS081161 }}</ref> The installation of the IPG and extension leads occurs under general anesthesia.<ref>{{cite web |title=Deep Brain Stimulation for Movement Disorders |url=https://www.neurosurgery.pitt.edu/centers/epilepsy/dbs-movement-disorders |website=University of Pittsburgh }}</ref>