Deep Brain Stimulation

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What do I have?

Deep Brain Stimulation (DBS) is a technique that is used in several conditions. Some of the most common applications are in patients with movement disorders (such as essential tremor, Parkinson's disease and dystonia) who are not responding to medical management. Recent clinical studies have suggested beneficial effects of DBS applied to other conditions such as depression, obsessive-compulsive disorder and epilepsy.

What does it do?

Although clinical response has been found to be remarkable in many cases, the exact mechanism of how the DBS works is unknown. The main concept is that delivery of high frequency electrical current in a very specific area of the brain, alters the fault circuitry of the brain and minimizes certain symptoms of the disorder.

After extensive investigation by a multidisciplinary team, involving neurosurgeons, neurologists, neuropsychologists etc. and if strict criteria are met, the appropriate candidate for this intervention is identified.

Surgical implantation of the three components of the DBS system (the implanted pulse generator (IPG), the lead, and the wire extension that connects them) can be done in one or two surgical steps.

Can it be cured?

Although DBS usually targets a specific symptom and can minimize the intensity to the level that the quality of life significantly improves, the overall prognosis depends on the underlying condition that causes the specific symptom.

How is it treated?

Three different phases of the procedure can be identified: preoperative, operative and postoperative.

• Preoperative: The patient undergoes an extensive preoperative clinical and laboratory examination to confirm the suitability for the procedure. This includes a MRI of the brain to depict the specific anatomy. If patient is on anti-Parkinson medication, these are held 12 hours before the procedure. The morning of the procedure, the patient is fitted with a titanium frame and a CT of the head is obtained with the frame on.
• Operative: After the appropriate area of stimulation (target) is defined by the surgical team, the patient is placed on the operative table. The lead (the surgical electrode that delivers electrical current in a specific area of the brain) is implanted initially, under continuous electrophysiological and clinical monitoring, while the patient is awake. Minimal sedation is used to keep patient comfortable. The rest of the system is implanted under general anesthesia. The IPG (a battery-powered neurostimulator, which sends electrical pulses to the brain through the lead) is implanted and connected to the lead through the extension wire. This can be done in the same setting or in a second operation, approximately a week later.
• Postoperatively: The patient is monitored in the hospital for one or more days. Once the whole system is implanted, the IPG would be calibrated to maximize the control of the symptoms and minimize side effects.
  
  As all surgical procedures, DBS has some risks with hemorrhage, infection, and mechanical failure being the most common.

What is special about our approach to treating this condition?

DBS has the advantage of avoiding permanent lesion to the brain with the ability to keep the option of possible future advanced treatments open. Also the stimulation parameters can be adjusted postoperatively in order to optimize therapeutic benefit for the patient.