Teknon Medical Center is equipped with the neuromate® stereotactic robot
The robot has 2D and 3D image registration and navigation providing the most accurate and least traumatic surgery performing in the world.
Teknon Medical Center has received over 10,000 neurological patients. It is one of the leading medical institutions working according to the international guidelines of Joint Commission International and quality standards of European Foundation for Quality Management.
The surgery at Rambam is provided by Professor with 30 years of Neurosurgery experience
Professor Zaaroor who was trained in the USA and Europe is a pioneer in innovative treatments for patients with essential tremor and Parkinson's.
Rambam Medical Center is an academical hospital, the second best hospital in Israel according to the Ministry of Health's National Quality Indicators Program of Israel. Rambam Medical Center receives and treats patients according to the international standards of JCI - medical safety and quality of health care control authority.
Rambam Medical Center is a partner of Medtronic - manufacturer of deep brain stimulators.
The Department is recognized as European Training Center of Excellence
Making it a leader among research centers in Neurosurgery.
The Department of Neurosurgery has over 60 years of treating experience. The Department receives over 15,000 patients per year. The neurosurgeons at Freiburg provide over 3,000 surgeries annually. Freiburg Medical Center has a regular program of neurosurgery clinical trials.
Prior Deep Brain Stimulation surgery a patient needs to undergo complete diagnostics, including MRIs of the head, cerebral vessels ultrasound, EEG, neuropsychological examination, Levadopa test, daily physiotherapy, occupational and speech therapies every other day. The program lasts 1-2 weeks.
If a patient is approved for the procedure, the total stay in Germany is 6 weeks. The aftersurgical check takes 4 weeks on the outpatient basis.
- What is Deep Brain Stimulation?
- Deep Brain Stimulation FDA approval
- DBS statistics
- Indications and contraindications for DBS surgery procedure
- Preparation for DBS surgery
- Process of DBS operation
- What happens after the surgery?
- Deep brain stimulator
- Deep Brain Stimulation side effects
- Deep Brain Stimulation reviews
- TED talk on DBS procedure
- DBS research
What is Deep Brain Stimulation?
- Parkinson’s disease;
- essential tremor;
- multiple sclerosis;
- obsessive-compulsive disorder;
- Tourette syndrome
Nowadays the DBS procedure is the most efficient treatment method for Parkinson’s disease.
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.
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 OCD
- in 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.
Factors affecting the price of the procedure:
- Neurosurgeons’ fee;
- Model and specifications of brain pacemaker;
- Length of hospital stay and/or rehabilitation period.
Indications and contraindications for DBS surgery
Indications for DBS procedure (on the example of Parkinson’s disease):
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
- examination by neurologist/neurosurgeon;
- complete blood count;
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 operationDeep 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.
When a patient is moving his hand, the doctor is adjusting the brain stimulator parameters
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 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.
The characteristics of deep brain stimulator effect ton the Deep Brain Stimulation surgery cost.
DBS side effects
- Problems with speech or vision
- Bad coordination
- Difficulty with coordination
- Problems with hardware
- Unwanted mood depression
- Sence of shocking.
All these side effects are short-term.
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
Does DBS mean craniotomy?
No, all the manipulations are made through small orifices (the size of the orifice depends on the neurostimulator device, qualification and experience of neurosurgeon).
Is the surgery provided under local or general anesthesia?
The first stage - electrodes insertion - of the surgery is provided under local anesthesia. The second - constant stimulator putting is performed under general anesthesia.
What complications could appear during and after the surgery?
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%.
What is the prognosis after DBS?
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.
What to do if battery of a deep brain stimulator runs out?
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.
Do I need to take medications after DBS procedure?
DBS reduces total medication dose by 30-50% and spread the intervals, but does not substitute medication therapy.
Can DBS not work?
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.
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.
Surgery is provided by Dr. Ali Zirh with experience of over 400 DBS
Dr. Zırh is a specialist in functional brain surgeries. He has provided over 1,000 successful interventions for Parkinson’s and other movement disorders treatment.
|Deep Brain Stimulation (DBS) surgery||35000 - 47850 $|
Medipol University Hospital is one of the leading Turkish medical institution assisting patients according to the international standards of JCI, responsible for safety of health care providing.
Top Spanish neurosurgeon works at HM Hospitals
The Head of the CINAC (Center of Neurosciences) neurologist Dr. José Ángel Obeso is recognized as the Doctor of the year by ABC Salud for his experience and achievements in neurological disorders treatment.
|Deep Brain Stimulation (DBS) surgery||43000 - 52000 €|
The price for DBS procedure includes the cost of stimulator and 7-10 days of hospitalization. The type and model of brain stimulator (pacemaker) is chosen by patient individually.
|Deep Brain Stimulation (DBS) surgery||42000 - 50700 $|
The Department specialists provide over 1,000 surgeries per year. At Ichilov the DBS procedure is provided in 1 or 2 phases. The method of stimulation is defined by the team of doctors basing on the general condition of a patient.
1-stage procedure requires 2 days of hospitalization.
DBS provided in 2 stages: after the 1st stage a patient stays in the hospital for 2-3 days, the 2nd stage requires 1 day and can be made only in 2 days after electrodes implanting.
Surgery is provided by top neurologist in Germany
Prof. Peter Berlit is awarded by Focus Magazine as one of the leading specialists in neurological disorders treatment.
Comprehensive preliminary examination prior DBS includes laboratory tests, histology, physical therapy, speech therapy, and other procedures if required.
The Department for Neurosurgery at Gachon University Gil Hospital receives 38,200 patients per year and provides 1,300 neurosurgical interventions.
The DBS is provided under 3T Imaging control. It is the most advanced diagnostic system which allows to detect area for stimulation with maximum accuraсy.
The patient’s stay in the hospital lasts from 7 to 14 days.
Apollo is the first hospital in India where DBS was provided. Institute of Neurosciences Expertise is the Center of Excellence at Apollo. Neurosurgeries have been provided here since 1960.