Deep Brain Stimulation
Deep brain stimulation (DBS) is an advanced medical treatment that uses implanted electrical impulses to control debilitating symptoms caused by a variety of movement and other neurologic disorders, or by psychiatric disorders. We work with the neurologists, psychiatrists, epileptologists, rehabilitation and pain management physicians, and neuroscientists to provide expert consultation and personalized treatment plans. We have been using this minimally invasive procedure for more than a decade.
Most commonly, DBS is used to treat Parkinson’s disease, essential tremor, epilepsy, treatment-resistant depression, obsessive-compulsive disorder, and dystonia. Recently, we have had great success with extreme cases of Tourette syndrome. DBS has been an important tool in treating Parkinson’s disease for more than two decades. Unfortunately, it has been under-utilized, with only 10 to 15 percent of patients opting for the surgery.
How DBS Works
To help someone using DBS, we start by using advanced imaging techniques to pinpoint the exact spot in the brain that is causing the problem. We thread a small wire with an electrode at the end through a small opening in your skull until the tip reaches the target spot. Then we connect the wire and electrode, using a small extension wire, to a small wristwatch-sized neurostimulator device that we implant just under your skin, near the collarbone. This enables us to send electrical current when necessary, much as we use pacemakers to “shock” the heart for patients with certain types of heart disease.
“In the same way a heart can have a ‘bad’ rhythm that leads to cardiac disease, Parkinson’s patients have ‘bad’ rhythms of electricity in their brains,” says Brian H. Kopell, MD, Director of the Center for Neuromodulation. “If we insert electrical devices to regulate these electrical activities we can help with their symptoms.”
Once we place the device, we program it to achieve maximum stimulation benefit. We program the length of the electrical pulse, the amplitude or voltage of the pulse, and the frequency (measured in hertz). We design a treatment plan specific to your situation, to optimize functionality and minimize side effects.
Often, DBS enables you to reduce your medication, which decreases the unpleasant side effects. Most patients feel symptom relief soon after the procedure and programming, and the relief is typically long term.
Who Is Appropriate for DBS Treatment?
An interdisciplinary team including a neurologist, neurosurgeon, neuropsychiatrist, neuropsychologist, and a psychologist evaluates the patient. The team will review the patient’s medical history including medications. During the evaluation, patients are videotaped to establish a baseline and provide the care team with a visual representation of the patient’s symptoms. The team then meets to gain consensus as to whether the patient is an appropriate candidate for DBS. If it is determined that the patient is eligible, further consultation will happen via telehealth.
General guidelines on whether the patient is a good candidate for DBS include:
- Symptoms for at least four years
- Review of medication history to assess symptoms on and off medication, as well as side effects
- Tremors or other symptoms the medication is not adequately controlling
- Limited duration of effectiveness of medication
- Symptoms that interfere with daily activities
The Latest Technology for Diagnosis
Mount Sinai West is the first hospital in New York City to use the Machine Medicine platform for evaluation. The technology uses computer vision, together with artificial intelligence, to analyze video of the patient’s movements to arrive at a standardized, objective assessment. Currently, this technology is being used during in-person outpatient visits to analyze the patient’s motor-related symptoms. However, patients will soon be able to generate videos at home on their own smartphone or tablet and link to the hospital’s patient portal. The evaluating team will be able to interact with the patient in real time and observe the symptoms while the Machine Medicine platform performs analysis. This approach will provide much more flexibility for the patient and the evaluating team. Since patients need to be videotaped on and off their medications, this innovative combination of telemedicine and technology will reduce the number of trips the patient will need to take into the office.
How to Get Started
If you are interested in DBS, these are the steps to get started:
- Call our office at 212-523-8340 and let us know that you are interested in DBS.
- Have the last few notes from your neurologist or primary care physician faxed to our office at 212-523-8342.
- After we have reviewed your records, we will call to set up an appointment with one of our movement disorder neurologists for further assessment.
- If our movement disorder neurologist determines that you might be a candidate, we will schedule standardized clinical testing with the neurologist and cognitive testing with one of our neuropsychologists.
- If we determine that you are a good candidate for DBS, we will schedule time for you to see your neurosurgeon and other members of the team to discuss DBS and whether it is right for you.
- Once you are determined to be a surgical DBS candidate, we will set a date for surgery and pre-surgical follow-up with Dr. Kopell.
If you have more medically or financially related questions, please call our offices at 212-523-8340. We will be happy to direct you in any way possible. We can help you with questions such as:
- Does my insurance cover DBS surgery?
- Will my neurologist be involved?
- What if my device needs to be replaced?