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Neurostimulators for deep brain stimulation (DBS) are called implantable pulse generators (IPG), precisely because all of them end up being implanted inside the patient's body. Now I get that the electrical current must get to the electrodes at some point, but why not either a) have the pulses be generated directly adjacent to the electrodes, instead of having the IPG somewhere in the chest or the abdomen or b) have the neurostimulator on the body instead of in the body, with the leads going transcutaneously to the electrodes?

I'm sure there has to be a good explanation, since the current IPG approach seems to be the only one in existence, but I can't for the life of me figure it out.

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    Hi David, as you may know, questions here are required to show results of prior research. As described in the help center and this meta post, this demonstrates that you’ve taken the time to try to help yourself, saves us from reiterating obvious answers, and helps you get more specific and relevant answers. Please edit your question with links to or references to what you've found in your search. Otherwise your question may be closed.
    – Ian Campbell
    May 2 at 16:39
  • As a start - you might want to think about battery life + replacement, Size, and what happens to external wires? for the various parts of your question.
    – bob1
    May 2 at 21:39
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    I've answered your question but I've also downvoted it for lack of prior research. If you edit it to add prior research, I will retract my downvote. We set the bar very low for prior research; just show us you at least tried.
    – Carey Gregory
    May 3 at 0:37

1 Answer 1

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TL;DR: Placing it in the chest or abdomen actually makes perfect sense.

There are several reasons why your ideas won't work, at least with current technologies.

why not either a) have the pulses be generated directly adjacent to the electrodes, instead of having the IPG somewhere in the chest or the abdomen

Because IPGs are the size of pacemakers, and you can't put an object that large inside the skull. There is no spare room inside the skull, so it would displace brain tissue, possibly causing injury, and it would be a much more difficult surgery with much higher risks. I would imagine that placing a tiny electrode and wire deep in the brain is difficult enough, but placing a device the size of an iPod would be vastly more difficult and dangerous.

Thanks to pacemakers, putting it in the chest or abdomen is perfected surgery that's performed hundreds of times a day worldwide in an outpatient setting with very low risk and an easy recovery. It makes perfect sense to put it there.

enter image description here Image source

or b) have the neurostimulator on the body instead of in the body, with the leads going transcutaneously to the electrodes?

This is addressed in comments by two people:

  • bob1 points out maintenance and external wires. Replacing a battery buried deep in your brain would be a major surgical procedure with significant risk. And having an external wire that can be caught on something and yanked out of place in your brain could have catastrophic consequences. Suffering brain damage from combing your hair seems an unreasonable risk.

  • Ian Campbell points out that having a wire going from your skin into your brain would be a major infection risk. Any external pathway from the outside world into your brain is dangerous.

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    The wires being a major infection risk was the missing piece for me, didn't realize it was such a major issue.
    – David Cian
    May 3 at 14:33

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