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Deep Brain Stimulation (DBS) surgery

What is Deep Brain Stimulation?

Deep Brain Stimulation (DBS) is neurosurgical procedure aimed at fast and effective treatment of neurological disorders as:
  • Parkinson’s disease;
  • essential tremor;
  • multiple sclerosis;
  • dystonia;
  • epilepsy;
  • obsessive-compulsive disorder;
  • Tourette syndrome
  • depression.

Nowadays the DBS procedure is the most efficient treatment method for Parkinson’s disease.

DBS system consists of three leading components: the leading wire (electrode), extender and brain stimulator. All the components, anesthesia, blood products, and other consumables are included into the Deep Brain Stimulation procedure cost.

Thin electrodes are inserted into the brain through small orifice with following deep structures stimulation by means of brain stimulator. The device is fixed under the skin in the chest area. The electrodes are connected to the stimulator by extension cord, which is held under the skin.

Deep Brain Stimulation system

Electrodes and brain pacemaker connection scheme

Clinics specialized in neurosurgery and Deep Brain Stimulation provide the operation with 100% accuracy and effectiveness.

Deep Brain Stimulation FDA approval

Deep Brain Stimulation surgery is approved by American Food and Drug Administration (FDA):

  • in 1997 - for Parkinson's disease and essential tremor treatment
  • in 2003 - for dystonia treatment
  • in 2009 - for OCDin 2016 - for the earlier stages of Parkinson's
  • in 2016 - for dystonia in pediatric patients.

FDA responses for protecting public health and ensures the principles of safety and security of medical devices, drugs and products.

Deep Brain Stimulation surgery cost

Deep Brain Stimulation prices in different countries:

Country and specializing clinic

Cost of DBS

Teknon Medical Center: Spain

  • procedure is provided by one of the best neurosurgery specialist in the world Dr. Bartolomé Oliver (more than 36 years of experience);
  • the most powerful equipment for the operation in the world - the neuromate® robot - the stereotactic device aimed at electrode implantation to the patients with minimum invasion.

University Medical Center Freiburg: Germany

  • Department of Neurosurgery on which basis DBS is provided is certified as European Training Center of Excellence.

Rambam Medical Center: Israel

  • its Department of Neurosurgery is the most reliable and nationally recognized in the country;
  • the team performing DBS consists is headed by Prof. Menashe Zaaroor (Director of the Department of Neurosurgery).

Medipol Hospital:Turkey

  • Neurosurgery & Neurology Department of the largest Turkish Private University Hospital;
  • Deep Brain Stimulation Surgery is performed by Dr. Ali Zırh (has provided more than 400 DBS procedures).

BLK Super Speciality Hospital: India

  • comprehensive Center of Neurosciences;
  • DBS surgery is provided by Dr. Rajiv Anand and Dr. Atul Prasad - known Indian neurology specialists.

KCM Clinic: Poland

  • Neurological Center provides DBS procedures since 2006;
  • over 50 foreigners have made Deep Brain Stimulation operation here.

Factors affecting the price of the procedure:

  • Neurosurgeons’ fee;
  • Model and specifications of brain pacemaker;
  • Length of hospital stay and/or rehabilitation period.

DBS statistics

Deep Brain Stimulation success rate, risks

Indications and contraindications for DBS surgery

Indications for DBS procedure (on the example of Parkinson’s disease):

  • Medications are non-effective;
  • Severe tremor and motor disturbance;
  • Painful dystonia;
  • Allergy or strong side effects after administration of medications.

There are no severe contraindications for DBS providing, however some relative ones could make the surgery or preparation for surgery more difficult, including:

  • patient is older than 75;
  • simultaneous thermoradiotherapy;
  • immunological suppression;
  • brain atrophy;
  • some psychological disorders, mental disability.

Preparation for DBS surgery procedure

Before DBS operation providing, a patient should undergo the following diagnostics:

  • examination by neurologist/neurosurgeon;
  • complete blood count;
  • ECG;
  • electromyography;
  • EEG;
  • MRI.

During the examination, the doctor clarifies whether patient has any allergic reaction on medications and anesthesia.

  • In the week leading up to the surgery, a patient is forbidden to take any anti-inflammatory agents.
  • Moreover, a patient is forbidden to smoke and take alcohol 1 week to and 2 weeks after the surgery, as this could cause bleeding. It’s also prohibited to eat and take any medications right before the surgery.
  • Patients should come to the hospital 2 hours before the surgery to finish with all written arrangements and be briefed on anesthesia effect and possible risks.

Process of the DBS operation

Deep Brain Stimulation surgery for Parkinson’s takes from 5 to 7 hours.

The operation is carried out by the team of at least 5 specialists: neurosurgeon, anesthesiologist, radiation therapist, neurologist, psychiatrist, who control functional abilities of the brain for maximum accurate impact on the zone of stimulation.

Stage 1. At the time of the operation a patient is under local anaesthesia, but remains awake. This is a mandatory requirement, as far as he/she is asked to move the extremities, fingers, eyes, or to say anything - to check and make sure electrodes do not stimulate off-target brain areas. All the impulses - firstly from the brain into the recorded device, and then vice versa - are transferred as structural information into the monitor. Data are processed in real time, which helps to adjust the device simultaneously. The orifice is closed with lead, surgery area is stitched.

Stage 2. After the electrodes adjustment, the temporary device is changed into constant brain stimulator.

DBS movement

When a patient is moving his hand, the doctor is adjusting the brain stimulator parameters

During DBS surgery the brain feels no pain, so a patient doesn’t feel any discomfort.

What happens after the surgery?

Patient feels the improvement in first hours after the surgery performing. The trembling in extremities disappears, movement coordination and speech articulation are renewed. Few days after the surgery sleeping and general health condition become better, pain is gone.

Patient after DBS

After the DBS surgery a patient with Parkinson’s disease is easily repeating the moves of the neurologist

Patient stays in the hospital for a week to adjust all the settings of the temporary device, afterwards the constant device is put into the chest or the abdomen of a patient.

Every 3 weeks after the procedure a patient is recommended to appoint neurologist to check the settings of the brain stimulator. 3-4 visits are required in general.

After the final neurostimulator programming, patient can control the parameters by him/herself, choosing the pre-installed regimes. As a rule, brain stimulator works 24h. There are different types of the neurostimulator devices: with battery and accumulator. Accumulator charge is 12-14 days, the total charge cycle is 1-2h.

Cell phones, beepers, microwave ovens, electromagnetic sensors do not affect brain stimulator.

Deep brain stimulator

Brain pacemaker is a small and sealed device containing a battery and electronics. It is placed into the patient’s chest or the abdomen. Its size is not bigger than heart pacemaker. DBS battery in general lasts 3-5 years. However, the service life depends on the settings and may be 1.5 and 9 years as well.

The deep brain stimulator can be rechargeable and non-rechargeable. This characteristic of DBS battery affects brain pacemaker cost.

A treating doctor will turn on the pacemaker with a wireless device (clinician programmer) and set up the programming sessions individual for the patient's symptoms relieving with minimum side effects. The procedure of setting can take a couple of hours.

Additional facts on brain pacemaker:

  • DBS stimulator activates the metal detector at the airport. All you need to do - show your card about the brain stimulator.
  • A person can have simultaneously neurostimulator and a cardiac pacemaker.
  • Neurostimulator should be on at any time, even when a patient goes to sleep.

Deep Brain Stimulation side effects

  • Problems with speech or vision
  • Bad coordination
  • Difficulty with coordination
  • Headache
  • Disorientation
  • Problems with hardware
  • Unwanted mood depression
  • Sence of shocking.

All these side effects are short-term.

Deep Brain Stimulation reviews

I made the decision of DBS providing by myself. My family gave me a support. The scariest thing for me was to become bedridden for the rest of my life. The surgery lasted for 7 hours and I remember everything, especially when they said they found the spot and everything would be great.

I married last year, now I have a child. It gave a second chance at life.

Jeff, the patient with dystonia from the USA

I first found out my tremor in the gym. I was shocked as I was so young. I woke up one day and realized I couldn't do it any more. The disease takes from you little by little who you are. I got tired very easily, I became slower. The doses of medications became higher and higher. I couldn't drive any more. And it became worse with time. DBS therapy changed me. It's unbelievable experience.
Thank God I live in a time for this kind of technology.

Kasandra, the patient with Parkinson’s disease from Italy

Deep Brain Stimulation - FAQs

No, all the manipulations are made through small orifices (the size of the orifice depends on the neurostimulator device, qualification and experience of neurosurgeon).

The first stage - electrodes insertion - of the surgery is provided under local anesthesia. The second - constant stimulator putting is performed under general anesthesia.

There are some possible complication that could arise during and after the Deep Brain Stimulation procedure: brain hemorrhage, infection, reaction to anesthesia. However, these conditions are rare and make out less than 1%.

Most of the patients still need to take medications after DBS procedure, however in much smaller quantity which significantly lowers the medication side effects (incl. dyskinesis - notwilled movement, caused by longstanding medication taking). More than 70% of people feel a compelling improvement of tremor, movement slowness, rigidity, walking and balance problems as well.

Neurostimulator is replaced surgically, leads and extensions of the system are stayed in place.

Deep Brain Surgery operation on one side is required to help symptoms on the opposite side of the body. Deep Brain Surgery procedure on two sides is recommended to provide improvement in motor function, especially if a patient has significant symptoms on both sides of the body.
In many clinics doctors firstly implant DBS lead on one side, adjust the setting and in a follow-up measure whether a patient needs a second DBS lead or not.

DBS reduces total medication dose by 30-50% and spread the intervals, but does not substitute medication therapy.

This option is possible and can happen because of improper patient selection, problems during the surgery, problems with the programming, disease progression. To avoid unnecessary risks, it's important to choose a center with experienced in DBS providing team.

TED Talk on DBS procedure

DBS research

For the mid 2017 Deep Brain Stimulation procedure has been a subject of various studies in terms of using the procedure to treat other diseases and mental conditions.

DBS operation has been considering as a method for Alzheimer's patients. Early studies have shown positive results, still some ethical issues remain. Research team of University of Pennsylvania School of Medicine is working on the solutions.

In American National Institute of Neurological Disease and Stroke and Institute of Mental Health the scientists have been investigating nonivasive DBS method - placing the electrodes on the scalp and not in the brain. The method was tested on mice and has been expecting a new stage of the study.

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