Dr. Moath A. Hamed, MD, FRCPC

A properly working immune system identifies foreign substances in the body that might cause illness, such as bacteria and viruses. The immune system then creates antibodies which attack the foreign substances, neutralizing them and keeping the body safe. In people with autoimmune disorders, something goes wrong with this process. For reasons that are not fully understand, the immune system creates antibodies to attack the patient's own tissues.

Symptoms of an autoimmune disorder depend on which tissue is being attacked by the immune system, but common symptoms of autoimmune disease include fever, fatigue, and a general feeling of just not being well. Autoimmune disorders are more common in women than in men, and they may run in families. Autoimmune disorders can affect various parts of the body such as blood vessels, connective tissue, endocrine glands, joints, muscles, red blood cells, skin, and many others.

It is common to have more than one autoimmune disorder at a time. Most are chronic, or life-long illnesses, although they may come and go in flares. Treatment for autoimmune disorders depends on which part of the body is being attacked. For example:

• A type 1 diabetic whose pancreas has been damaged will need insulin.
• A person with Hashimoto's whose thyroid has been damaged will need replacement thyroid hormones.
• Someone with Sjogren's syndrome will need eye drops and mouth rinses to replace tears and saliva.

Many autoimmune disorders of all kinds are treated with immune-suppressing medications, such as corticosteroids (e.g. prednisone) to reduce the effect of the immune system.

DBS surgery may be completed in one operating session, but it is more commonly performed in two parts. In the first stage of the procedure, the surgeon will map targets in the brain using CT or MRI imaging to determine where to place the electrodes. Then, by drilling holes into the skull, the surgeon will place the electrodes into specific areas in the brain. The holes will be closed, and patients will require 1-2 days to recover in the hospital. After about two weeks, patients will undergo another surgery to have the deep brain stimulator implanted. The stimulator is usually placed under the skin around the collarbone, chest, or abdomen, and it will be connected to the DBS electrodes through a subcutaneous wire. No component of the DBS system will be visible from outside. Following stimulator implantation, patients may need to recover in the hospital for 1-2 days.

Within 2-4 weeks of the operation, doctors will program the stimulator using a wireless device. Patients will work with their doctor to determine the most effective settings for the stimulator during follow-up visits. Patients will be given a handheld device so that they can turn the stimulator on or off and adjust its settings themselves. The stimulator may have a rechargeable battery, in which case patients will be given a charging unit. Stimulator batteries generally need to be replaced in 3-5 years.