Deep Brain Stimulation (DBS)

Deep brain stimulation is a surgical treatment in which a neurosurgeon uses an implanted device. It delivers an electrical impulse directly to that part of the brain, the work of which was disrupted due to the disease. In the past, deep brain stimulation (DBS) was only used to treat Parkinson’s disease and epilepsy. However, modern research has shown that DBS also helps with many other conditions.

DBS (DBS) treats pathologies that adversely affect the functioning of neurons – a key type of brain cells. When neurons don’t work properly, it disrupts important bodily functions such as motor and intelligence. The patient may partially or entirely lose these functions depending on how severe the medical problem is.

DBS – what is it? The abbreviation in English stands for Deep Brain Stimulation (in the English language brain – the brain), that is, deep brain stimulation. This is the name of the method of surgical treatment, which is often used abroad to combat psychiatric neurological disorders.

The DBS procedure is approved by the U.S. Food and Drug Administration (FDA) for the treatment of:

• dystonia – a movement disorder that causes involuntary contraction and twisting of muscles in different segments of the body;
• essential tremor – uncontrollable hand tremor (usually hereditary);
• drug-resistant epilepsy – a type of disease in which pharmacological drugs are ineffective;
• Parkinson’s disease – a degenerative disease of the brain, accompanied by an impaired motor (slowness of movement, tremor, muscle rigidity and loss of balance), cognitive functions and sleep;
• Drug-resistant obsessive-compulsive disorder (OCD) is a neurotic disorder with obsessive thoughts and fears that cannot be treated with tranquilizers and antidepressants.

According to the Cleveland Clinic Research Center, DBS has a positive effect on the brain in other conditions as well. In foreign medical centers, DBS is used in complex therapy:

• cluster headache – a series of attacks of pain syndrome in a limited period of time (from several weeks to several months);
• severe pain disorders – pain that occurs against the background of incurable or complex diseases, such as cancer;
• Alzheimer’s disease – a disease of the nervous system, which becomes a common cause of dementia (dementia) in people over 65 years of age, accompanied by a loss of cognitive functions;
• Tourette’s syndrome – a disorder of the central nervous system (CNS) characterized by repetitive sudden muscle contractions (especially in the neck), shouting and other vocal abnormalities;
• eating disorders – anorexia nervosa and bulimia, psychogenic overeating;
• drug-resistant depression – a severe form of the disease in which drugs are ineffective;
• schizophrenia – a polymorphic mental disorder accompanied by a bifurcation of the intellectual and emotional-volitional functions (hallucinations, false memories, uncontrolled actions);
• Drug addiction is an addiction to any drug.

Some doctors abroad use DBS for endogenous depression – a complex emotional disorder that is accompanied by a change in the amount of neurotransmitters and hormones in the body.

In advanced clinics abroad, deep brain stimulation was approved in the 1990s for the treatment of movement disorders. DBS involves placing electrodes close to deep structures in the brain. The neurosurgeon connects these electrodes to a pulse generator that is implanted subcutaneously into the chest wall. The pulse generator is controlled by a computer, which instructs the electrodes to fire.

Common structures targeted by DBS include the subthalamic nucleus, the globus pallidus internus, and the ventral intermediate nucleus of the thalamus. According to research by the US National Institutes of Health, stimulation of the ventral intermediate nucleus of the thalamus through the DBL leads to a decrease in tremor by more than 80%. At the same time, other unpleasant neurological symptoms also gradually disappear.

Before the DBS operation, the patient will need medical tests. That way, doctors can assess the potential risks and make sure that deep brain stimulation is a safe and appropriate option for the case. Before DBS, doctors usually do brain tests, including an MRI. The research helps to map the areas of the brain where the electrodes will be implanted.

The main two stages of Deep Brain Stimulation:

1. Operation on the brain. For the intervention, a special frame (stereotactic frame) is fixed on the patient’s head to ensure immobility. Medical team members then use neuroimaging (MRI or CT of the brain) to determine the area where they will place the electrodes.

In most cases, the electrode is placed when the person is awake. This is done to ensure the desired effect of stimulation and to maintain the activity of important areas of the brain. In this case, a local anesthetic is injected into the person to numb the scalp before the procedure. In the brain itself, anesthesia is unnecessary because there are no pain receptors in it. In rare cases, the operation can be performed under general anesthesia.

The neurosurgeon implants a thin wire electrode with a series of contacts at the ends into the desired area of the brain. A wire runs under the skin to a pulse generator (neurostimulator) implanted near the collarbone. During the operation, the neurologist, surgeon and other medical staff carefully monitor the patient’s condition to ensure the correct placement of the electrodes, which will later give a signal.

2. Chest surgery. During the second part of the operation, the surgeon implants the part of the device containing the battery (pulse generator) under the skin of the chest near the collarbone.

At this stage, doctors introduce the patient to a state of general anesthesia. Wires from the brain electrodes are placed under the skin and guided to a battery-powered pulse generator. The generator is programmed to supply continuous electrical impulses to the brain. Then, the patient will control the generator, and you can turn it on or off using a special remote control.

Rehabilitation lasts 3-4 days. During this short time, the patient’s surgical field heals, which is about 1 cm in diameter. After the DBS procedure, the patient visits the clinic on an outpatient basis for several weeks. The doctor finally adjusts the apparatus for neurostimulation using a programmer. As a rule, this requires up to 5 visits to a neurologist.

For successful rehabilitation after brain stimulation, the patient is forbidden to drink alcohol for at least 2-3 weeks. The operation of a smartphone and other electronic devices will not affect the operation of the machine.

When can I see results after deep brain stimulation?

The improvement is noticeable on the first day after the operation: the tremor in the limbs decreases or disappears completely, speech and coordination of movements are restored. After a few days, sleep and general condition normalize.

The Spanish clinic Teknon is one of the leading centers in the world, where famous neurosurgeons work and perform deep brain stimulation. The best specialist in a medical institution is Gerardo Conesa Bertrand. The neurosurgeon has over 30 years of experience and is the director of the Teknon Institute of Neurosurgery and Neurobiology. The clinic also employs a world-famous doctor, neurologist, and specialist in the field of functional neurosurgery with more than 40 years of experience – Bartolome Oliver.

In the multidisciplinary clinic Medipol in Turkey, the treatment of parkinsonism, dystonia and other disorders of the central nervous system is carried out by Ali Tsirkh. The main specialization of the doctor is deep brain stimulation. The doctor has over 35 years of experience in the field of neurosurgery.

In Israel, you can consult a neurosurgeon, neurologist or epileptologist at the country’s leading medical centers – Sourasky and Herzliya. In South Korea, the Gil University Hospital accepts foreign patients with severe neurological pathologies.

The cost of deep brain stimulation in clinics in different countries is different. In some medical centers, package offers are available to patients, which will be more advantageous in price. They include diagnostics before surgery, DBS operation, accommodation in a comfortable room and transfer from the airport.

To undergo a DBS procedure in one of the best hospitals in the world, leave a request on the Experts Medical website. A medical coordinator will contact you to help you choose a doctor and arrange a trip abroad.

With the support of Experts Medical, patients can count on:

• assistance in choosing a hospital and the best DBS specialist;
• translation of medical documents and sending them for consideration to a foreign neurosurgeon;
• quick organization of the trip together with an accompanying person (this may be a relative of the patient);
• booking airline tickets and transfer from the airport to the hospital.

You can learn all the details about deep brain stimulation abroad during a personal consultation with an Experts Medical specialist.