DEEP BRAIN STIMULATION

What is Deep Brain Stimulation?

What is Deep Brain Stimulation (DBS): A Comprehensive Guide

Introduction to Deep Brain Stimulation (DBS)

Deep Brain Stimulation (DBS) represents a significant advancement in the treatment of various movement disorders. This surgical procedure involves the implantation of a medical device known as a neurostimulator and electrodes, which delivers electrical impulses to specific areas of the brain. These impulses help regulate abnormal brain activity, offering symptomatic relief for conditions such as Parkinson’s Disease, Dystonia, and Essential Tremor. For patients grappling with debilitating symptoms, DBS provides a pathway to improved motor function and enhanced quality of life.

Understanding the Technology

How DBS Works

The technology behind DBS is both sophisticated and precise. The procedure usually involves two main components: the implantation of electrodes into targeted brain areas and the placement of a neurostimulator device under the skin, typically near the collarbone. The electrodes are connected to the neurostimulator via thin, insulated wires. Once activated, the neurostimulator sends out controlled electrical pulses that modulate neural activity in the targeted brain regions. This regulation alleviates symptoms of diseases such as Parkinson's Disease, Dystonia, and Tremors, which significantly impact patients' lives.

The Surgical Procedure

DBS surgery is conducted in stages. Initially, the electrodes are implanted during a craniotomy, where small holes are drilled into the skull. Advanced imaging techniques such as MRI and CT scans guide the precise placement of these electrodes. Following the electrode implantation, the neurostimulator is implanted during a separate procedure. Post-surgery, the device is programmed and fine-tuned to deliver optimal stimulation settings tailored to the patient’s needs.

Conditions Treated with DBS

Parkinson’s Disease

Parkinson’s Disease is a progressive neurological disorder characterized by tremors, rigidity, and bradykinesia (slowness of movement). DBS has proven to be highly effective in managing these symptoms like resting tremor, rigidity, freezing on gait, dyskinesia and walking problem especially in patients who do not respond well to medication.

Dystonia

Dystonia is a movement disorder that causes involuntary muscle contractions, resulting in repetitive or twisting movements. DBS offers significant relief by targeting brain areas responsible for the abnormal muscle activity. Deep Brain Stimulation (DBS) is particularly effective for treating conditions such as Cervical Dystonia, Tardive Dyskinesia, Mycolonic Dystonia, Orofacial Dystonias like Meige Syndrome, and primary (genetic) Dystonia.

Essential Tremor

Essential Tremor is a neurological disorder that leads to rhythmic shaking, typically affecting the hands. By modulating the brain’s electrical signals, DBS can significantly reduce tremor severity, allowing patients to perform daily tasks more easily. At our center, we have developed a significant technique known as the "double target." This innovative method allows us to address two critical structures with a single electrode, effectively treating severe types of tremors. Using this technique, we can alleviate even the most severe and rare tremors, such as Holmes Tremor, Head Tremor, Cerebellar Tremor, and Voice Tremor. 

Benefits of DBS

The potential benefits of DBS are numerous and impactful:

Risks and Side Effects

While DBS offers substantial benefits, it is crucial to consider potential risks and side effects, which include two important risks but are not limited to:

Infection: Post-surgical infections can occur, necessitating medical intervention. 

At our center, we specialize exclusively in Deep Brain Stimulation Surgery. This focus ensures that all team members, including surgical nurses, are highly experienced and know exactly what is required to provide comprehensive patient care. To minimize infection rates, we utilize state-of-the-art technological devices and administer highly effective antibiotics during and after surgery. Because our entire team dedicates itself solely to Deep Brain Stimulation procedures, we maintain the highest standards of sterility. As a result, our center's infection rates are significantly lower than the average reported in the literature.

Bleeding: Although rare, there is a risk of intracranial bleeding during the electrode implantation process. To mitigate this risk, our center obtains MRI images under general anesthesia with contrast enhancement. This contrast-enhanced MRI allows us to visualize all vascular structures in the brain, ensuring we avoid any blood vessels when placing the electrodes. Using a stereotactic frame, we achieve exceptional sensitivity and accuracy, calculating trajectories to within one-tenth of a millimeter. This precision helps us identify the optimal path to avoid disturbing or harming any vessels. Furthermore, we employ state-of-the-art stereotactic frames, enabling us to position the electrodes accurately without contacting any vessels. These advanced techniques significantly reduce the risk of bleeding to very low percentages. 

Preparing for DBS Surgery

Pre-Operative Evaluation

Patients undergoing DBS surgery will undergo a comprehensive evaluation to determine their candidacy. This includes general assessments, neurological evaluations, imaging studies such as MRI and CT scans, and psychological evaluations to ensure suitability for the procedure. At our center, each patient is seen by a team comprising a neurosurgeon, a neurologist specializing in movement disorders, a psychologist, a physical therapist, a rehabilitation specialist, an anesthesiologist, and, if necessary, a nutritionist. Before deciding on the surgery, we must ensure that the patient will benefit from it and that the outcome will meet the expectations of both the patient and their relatives. Our goal is not just to perform surgery; it is to enhance our patients' quality of life, meet their expectations, and send them back to their home countries healthy, happy, and satisfied.

During the Surgery

Patients are typically awake during the electrode implantation stage, allowing surgeons to assess immediate responses to stimulation and to find the best beneficial area for the patient. The neurostimulator implantation, however, is performed under general anesthesia.

Post-Surgery Recovery

Post-operative care involves close monitoring for any complications and adjustments to the neurostimulator settings to achieve optimal results.

Managing Expectations

Understanding what DBS can and cannot achieve is essential for patients considering this treatment. While DBS can significantly alleviate symptoms, it is not a cure for movement disorders. Patients should have realistic expectations about the improvements in their quality of life and the potential need for ongoing adjustments to their treatment regimen.

Post-Operative Care

Effective post-operative care is vital for the success of DBS treatment. This includes regular follow-up appointments for device programming, Dressing and attending to the wounds, removal of the stitches, monitoring for complications, and participation in rehabilitation especially walking rehabilitation programs to maximize functional outcomes.

Long-Term Follow-Up

Long-term follow-up is a crucial component of Deep Brain Stimulation (DBS) therapy, ensuring that patients continue to benefit from the surgery while minimizing the impact of disease progression. Regular follow-up appointments are necessary to fine-tune the neurostimulator settings, as patients' symptoms can evolve over time and may require adjustments. During these in-person or online visits, our multidisciplinary team evaluates the patients' overall health, reviews any changes in symptoms, and makes necessary modifications to the DBS device programming and medication. Additionally, we manage and optimize medication plans in conjunction with DBS therapy to maintain the highest possible quality of life. Our center emphasizes a comprehensive approach to follow-up care, incorporating physical therapy, psychological support, and continuous education about managing life with DBS, thereby ensuring sustained long-term success for our patients.

How to Qualify for DBS

Eligibility Criteria

Candidates for DBS must meet specific criteria, including:

Evaluation Process

A multidisciplinary team of neurologists, neurosurgeons, and psychologists will conduct a thorough evaluation to determine suitability for DBS.

The Future of DBS

Recent advancements in DBS technology continue to enhance its efficacy and safety. Innovations such as adaptive DBS, which adjusts stimulation levels in real-time based on brain activity, and remote programming capabilities, are paving the way for more personalized and effective treatments. The future holds promise for even more refined and accessible DBS solutions.

Our Center’s Expertise

At our center, we have successfully conducted over 700 DBS surgeries, drawing patients from 37 countries, including the USA, England, France, Germany, the Netherlands, and regions across Central Asia (like Uzbekistan, Kyrgyzstan, Tajikistan, Kazakhstan, Azerbaijan, and others), Africa (such as Nigeria, Ghana, Zambia, Mauritius, and others). Our state-of-the-art facilities in Istanbul, Turkey, and our commitment to excellence make us a leading destination for DBS treatment.

The Importance of Choosing the Right Center for DBS Surgery

It is crucial to remember that while Deep Brain Stimulation (DBS) significantly alleviates the symptoms of movement disorders, it is not a cure for these diseases. Successful DBS treatment can enhance patients' quality of life by managing symptoms more effectively than medication alone. However, the outcome greatly depends on the expertise and comprehensive care provided by the chosen medical center. Therefore, when deciding on a center for your DBS surgery, consider the facility's experience, technological capabilities, infection control measures, and the multidisciplinary approach to both the pre-and especially post-operative phases. Making an informed decision about the center will help ensure you receive the highest standard of care, ultimately leading to the best possible outcomes.

Conclusion

Deep Brain Stimulation stands as a transformative treatment option for individuals suffering from movement disorders. By understanding its benefits, risks, and the comprehensive care involved, patients can make informed decisions about pursuing this advanced medical intervention. If you are considering DBS as a treatment option, we encourage you to seek professional advice and explore the potential for a significantly improved quality of life.

Call to Action

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