Asleep Deep Brain Stimulation

Deep brain stimulation (DBS) is a type of brain surgery in which electrodes are implanted into specific targets in the brain. The targets are chosen according to the disorder that we are treating. The primary goal of the deep brain stimulation procedure is to improve the patient’s quality of life by managing symptoms, not to cure the disease or disorder.

Deep brain stimulation surgery involves the placement of three device parts into the body. They are all implanted below the skin. The first part is the wire(s) that go into the brain. These are also called leads or electrodes. The second part is the battery pack/generator. This is placed in the chest just below the collar bone. The last part is the wires that connect the leads to the generator.

Target stimulation starts once the device has been turned on. This usually happens approximately two weeks after surgery. Some symptom relief is immediate (such as tremor control) and some results can take several months to occur.

Neuroscientists do not yet know exactly how deep brain stimulation works. Many specialists, however, believe that the electrical stimulation provides relief by interrupting the irregularly firing circuits in the brain. These irregularly firing circuits cause the symptoms, so regulating these circuits could serve to decrease or eliminate symptoms. In a general sense, deep brain stimulation can be described as a pacemaker for the brain.

Unlike other surgical options available, the effects of deep brain stimulation are reversible and do not permanently damage brain tissue. In addition, there is the ability to adjust, or program, the stimulation to better capture symptoms.

As the name suggests, Asleep DBS surgery is performed while the patient is asleep, and is a surgical option from patients suffering from Parkinson’s, dystonia, and some psychiatric disorders. The surgery takes place in two parts, with the first procedure lasting less than 4 hours under general anesthesia. Asleep DBS is performed using our most advanced brain imaging technologies, in the Advanced Multimodality Image Guided Operating (AMIGO) suite. The AMIGO suite is a state-of-the-art medical and surgical research environment that houses a complete array of advanced imaging equipment and interventional surgical systems.

Before Surgery:

Before a patient is approved for and undergoes a deep brain stimulation (DBS) procedure, there are five basic pre-operative steps that take place.

Step 1: Formal appointments during DBS Clinic with each of the following deep brain stimulation specialties – neurology, neurosurgery, psychiatry, and neuropsychology. Our Program Coordinator will help facilitate making all of these appointments.

Step 2: The patient will get a brain MRI with gadolinium (a contrast agent used to enhance MRI images) and an MRI without gadolinium. In order to obtain the best images, we try to schedule imaging for when the patient is experiencing the least amount of symptoms. Mild sedation may be used if necessary. Please let us know if you have had spine surgery or have chronic back pain.

Step 3: Your case will be discussed at a committee meeting to determine if you are an appropriate surgical candidate and if you will benefit from a deep brain stimulation procedure. The DBS Surgical Planning Committee meets to address movement disorders and the DBS Steering Committee meets to address psychiatric disorders.

Step 4: You will be notified, along with your referring physician, of the committee results. If you are a candidate, we will begin surgical scheduling immediately. If you are not a candidate, we will discuss other potential treatment options with you and your referring physician.

Step 5: You will receive two appointments before your surgery. The first will be at the Weiner Center to get necessary testing and meet your anesthesiology team. The second will be with neurosurgery to sign your surgical consent form and ask any questions. You also will receive written preoperative instructions that tell you when to arrive at the hospital on the day of your surgery and which medication(s) you should stop taking at midnight prior to surgery.

During Surgery:

Step 1: In most cases, the patient is expected to arrive at the hospital by 5:30 am. At approximately 6:30 am, our team will meet the patient in the pre-operative area. We will shave the necessary portions of the head and inject the patient with some numbing medication. The patient then will be brought into the MRI suite and given general anesthesia. This enables the patient to remain asleep throughout the entire surgery. Next, we drill the burr holes and place the electrodes under MRI guidance. The surgical day is generally shorter than what is required for awake DBS, and most patients leave the hospital the next day.

Step 2: The second part of the procedure, which takes place approximately one week after step 1, involves placing a battery pack just below the patient’s collar bone and connecting it to electrodes that were placed in the patient’s brain during Step 1. All patients will be asleep for this step, which takes about two and a half hours. Most patients go home the next day.

After Surgery:

Step 1: Approximately two weeks after Step 2 of the surgery is completed, patients will be seen by one of our experts for initial programming. Patients will be asked to temporarily stop taking your medications shortly before this first appointment, which typically lasts two to three hours. If the patient was referred by a neurologist with knowledge of programming, your initial and subsequent programming will probably be with them. It is important to note that during the first couple weeks immediately after surgery, it is not uncommon for your family to notice that you are slightly confused or disoriented. This is temporary and will go away in two to three weeks after surgery.

Step 2: Patients will need to return for several additional follow-up visits for stimulation and battery-life monitoring. These appointments will be more frequent and lengthy during the first 3-6 months. These appointments are important for fine-tuning the programming, allowing us to best capture your symptoms and improve your quality of life. After this three to six month fine-tuning period, your programming appointments will become less frequent and less lengthy.  


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