Deep Brain Stimulation (DBS) surgery
- What is Deep Brain Stimulation?
- Deep Brain Stimulation FDA approval
- DBS surgery cost
- 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 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
University Medical Center Freiburg: Germany
Rambam Medical Center: Israel
KCM Clinic: Poland
- 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.
Deep Brain Stimulation 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.