Deep Brain Stimulation
What is Deep Brain Stimulation (DBS)?
DBS procedure involves the implantation of electrode arrays into the brain and the insertion of the implantable pulse generators (IPGs) that drive the system. DBS alleviates various symptoms of many neurological disorders by applying electrical fields in specific regions of the brain. Currently, DBS is being used predominantly for people suffering from movement disorders such as Parkinson’s disease and essential tremor. But other indications are on the horizon. Unlike other forms of movement disorder surgery (i.e. pallidotomy and thalamotomy), DBS can be modified over time and is fully reversible.
The operation is done in two stages. The first stage requires a postoperative, overnight stay. The DBS leads themselves are implanted stereotactically, using computer aided targeting while the patient is awake. We use microelectrode recordings and microstimulation as well as macrostimulation to accurately guide and position the electrode array. This stage of the implantation is all done through a 14mm (less than half an inch) hole. The second stage is an out-patient procedure. The IPG is connected to the DBS lead. Under general anesthesia this connection is tunneled under the skin to a pocket under the collar bone, where the battery pack and pulse generating unit are placed. This procedure takes about 45 minutes for each IPG. After recovery the patient is sent home with wound care instructions and a DBS patient information booklet. Follow-up with the neurologist and neurosurgeon with adjustments to the IPG and wound checks are scheduled before the patient leaves the hospital. IPG adjustments are done in the office using a magnet over the unit without even removing any clothing. These adjustments are done in conjunction with medication adjustments.
At National Capital Neurosurgery we emphasize a team approach to diagnosis, management, surgical targeting and follow-up care for DBS. Our team includes a neurosurgeon, neurologist, and neurophysiologists, who all have experience in movement disorders and their management. We believe this team approach provides the patient the best possible care. Consultation with both the neurosurgeon and the neurologist are necessary prior to any decisions about eligibility for surgery. The neurosurgeon and neurophysiologist work together in the operating room to ensure accurate targeting and the best results possible from the surgery. Follow-up care is done both by the neurologist and the neurosurgeon. The neurologist manages the actual programming of the stimulator and the neurosurgeon follows the patient for wound healing and other surgical issues. The patient’s care and progress is the essential focus for the team.
Who are Eligible Candidates?
Individuals suffering from Parkinson’s disease (PD) who are not tolerating medical therapy or who cannot tolerate some of the side effects of the medications (dyskinesia in particular) are eligible candidates for DBS. Medical therapy is the first line of treatment in PD and thorough trial of medications and extensive follow-up with a neurologist is important before surgery can be considered. Those individuals who have benefited from or responded well to levodopa or Sinemet therapy are better candidates. Previous pallidotomy or thalamotomy does not exclude one from DBS. In fact patients who have benefited from these procedures will most likely benefit from DBS. All cardinal features of PD are treated with DBS. Freezing, stiffness, and tremor all show improvement with DBS in the subthalamic nucleus. Dyskinesia also shows improvement as the amount of medication is decreased as the stimulator is adjusted. Those with essential tremor (ET) who are growing “resistant” to the medication or who are suffering from medication side effects, are good candidates for thalamic DBS. Extensive work-up and medical therapy should always precede surgery for ET.
How Do I Get Started?
If you wish to have an initial consultation, you may call (301) 718-9611 and ask for a DBS consultation with Dr. Zachary Levine. Please bring with you a list of medications and your dose schedule. We will need this for our records. In addition, we will need the name of your primary care physician as well as your treating neurologist. If you have had any MRI or CT scans of your brain, please bring them or arrange to have copies sent to our office.