Deep Brain Stimulation and Cortical Stimulation
Deep Brain Stimulation
Deep brain stimulation (DBS) is an advanced medical treatment offered at the Center for Neuromodulation at Mount Sinai that uses implanted electrical impulses to control debilitating symptoms caused by a variety of movement and other neurologic disorders.
Our neurosurgeons have been using this state-of-the-art surgical treatment for more than a decade, providing relief to patients with complex cases who have not responded to traditional therapies or medication. In collaboration with the neurologists in the Robert and John M. Bendheim Parkinson and Movement Disorders Center, our team of specialists can provide expert consultation for this treatment as well as personalized treatment plans to help patients achieve a better quality of life.
Deep Brain Stimulation for Parkinson’s disease and Other Disorders
Deep brain stimulation is most commonly used to treat the symptoms of these common neurological conditions:
- Parkinson’s disease
Deep brain stimulation was approved by the Food and Drug Administration (FDA) to treat Parkinson’s disease in 2002 and is now a standard treatment for this condition. Over time, the symptoms associated with Parkinson’s, which include stiffness, slowness, and tremor, become resistant to the medication. The symptoms will fluctuate as the medications provide relief for only a few hours at a time. For these patients, deep brain stimulation can offer steady symptom control for 24 hours per day, to provide better quality of life.
- Essential Tremor
When patients have inadequate response to medication, deep brain stimulation is an option to effectively treat essential tremor. Research shows that medications often only elicits a response in about half of patients with essential tremor. However, patients who undergo deep brain stimulation can experience approximately 80 percent improvement in hand tremor.
Dystonia is a condition in which patients experience involuntary muscle contractions that force parts of the body into abnormal postures. DBS has been FDA approved for this condition under what is known as the Humanitarian Device Exemption (HDE.) This means that DBS surgery can be done on those with debilitating dystonia that does not respond well to medication, and in whom dystonia is the only neurological condition. Geneticist Dr. Tatiana Fuchs is leading a multi-center study to examine the genetics of those who best respond to deep brain stimulation for dystonia in order to better personalize this treatment to those most likely to benefit.
- Obsessive Compulsive Disorder (OCD)
Deep brain stimulation has been approved by the FDA under the Humanitarian Device Exemption (HDE) for the treatment of obsessive compulsive disorder (OCD.)
How Does Deep Brain Stimulation Work?
A neurosurgeon uses advanced imaging techniques to visualize the exact spot in the brain where the electrical impulses are needed to normalize motor (movement) function. The surgeon then threads a small wire with an electrode at the end through a small opening made in the patient’s skull until the electrode at the tip reaches the target spot. That wire and electrode are then connected, via another small extension wire, to a small wrist-watch sized neurostimulator device implanted just under the patient’s skin near his collarbone in much the same way a heart pace-maker is implanted in the chest of 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 Dr. Brian H. Kopell, Director of the Center for Neuromodulation. “If we insert electrical devices to regulate these electrical activities we can help with their symptoms,” he said.
Deep Brain Stimulation Personalized for Each Patient
Neurosurgical placement of DBS is followed by programming of the device by highly skilled physician programming experts intent on achieving maximum stimulation benefit. Even a well-placed lead, if not properly programmed, will fail to provide significant benefit. Three main parameters must be carefully programmed in DBS:
- Length of the electrical pulse
- Amplitude or voltage of the pulse
- Frequency (hertz) at which the pulse is delivered
An expert in neuromodulation programming will adjust each of the above parameters to the specific anatomic and symptom profile of each patient in order to optimize their functional status and minimize side effects.
Often, once ideal programming of the DBS has been achieved, patients are able to reduce their medications, lessening the unpleasant side-effects that can come with high doses of Parkinson’s disease medication. Patients often notice lasting symptom relief soon after surgery and programming of their device.
Do I Qualify for Deep Brain Stimulation?
Deep brain stimulation is an advanced procedure designed to treat neurological conditions that have not responded to traditional therapy. To qualify for deep brain stimulation, patients with Parkinson’s disease must have one of the following three symptoms:
- Medically refractory tremor
- Fluctuations between “On Time” (medications are working and symptoms are under control) and “Off Time”(medications are not working or are giving adverse side effects)
- Uncontrollable dyskinesia
- Patients with essential tremor must have medication refractory tremor
- Patients with dystonia must have medication refractory, debilitating dystonia
Our team of experts can provide a thorough evaluation and determine whether DBS is the best therapy for you. To schedule an evaluation, call 212-241-0050.
Surgery in general should never be taken lightly - it should not be done unless there is sufficient evidence that you will benefit from surgery. We have a team of physicians who will determine if this is the right treatment for you and to ensure the best possible outcome.
If you are interested in DBS, please follow these steps:
- Call our office at 212-241-0050 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 212-410-0603
- After the records have been reviewed, you will receive a 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, standardized clinical testing with the neurologist along with cognitive testing with one of our neuropsychologists will be scheduled
- Based upon the above evaluations, if you are deemed a candidate, you will be scheduled to see neurosurgeon Dr. Kopell to discuss DBS and whether surgery is right for you
- Once you are determined to be a surgical DBS candidate, a date for surgery will be arranged along with pre-surgical follow-up with Dr. Kopell