Deep Brain Stimulation (DBS) for Dystonia
Electrical stimulation of the brain to treat dystonia
Expert Treatment for Dystonia
Beth Israel Deaconess Medical Center (BIDMC) neurologists offer deep brain stimulation (DBS) to treat dystonia. Some people with dystonia benefit from a surgical treatment called globus pallidus deep brain stimulation (GPi DBS). GPi DBS is a treatment that involves electrical stimulation of the brain. We perform GPi DBS in multiple stages. Your doctor will consider many factors before deciding if you might benefit from this procedure.
Candidates for DBS
DBS treatment works best for those who have jerky movements with their dystonia. You may be a candidate for this treatment if you meet these criteria:
- Have disabling dystonia
- Have the DYT1 genetic mutation
- Are able to travel to BIDMC for frequent follow-up visits over the first three months after surgery
If you’ve had a poor response to Sinemet in the past, you are not likely to benefit from DBS.
Getting Started
If you and your doctor decide that you might be a good candidate for this surgery, you’ll meet with a number of specialists on our team. You’ll have a series of exams and tests.
Through this process, we’ll be better able to tell if there is a good chance the surgery will help you without posing any unusual risk. The process will include these steps:
- Neuropsychological testing — You’ll meet with a neuropsychologist who will administer tests to evaluate your thinking, memory and mental health.
- Meeting with the neurosurgeon — You’ll also meet with the neurosurgeon who will perform the operation. During a thorough exam, you’ll have a chance to talk about any questions or concerns you may have about the surgery. You also may need a brain MRI.
Once all these exams are complete, our team will look at the results and decide whether or not surgery is the best option for you. We may recommend that your next steps involve medications or other treatments.
If we recommend surgery, we usually schedule it within one month. Once we schedule your surgery, you’ll get details about coming to the hospital for routine pre-operative tests.
More About DBS for Dystonia
To help prevent bleeding, you should not take these or any blood thinners for at least two weeks before surgery:
- Anti-inflammatory drugs
- Arthritis medications
- Aspirin
- Heparin
- Warfarin (Coumadin)
Stage 1: Inpatient Surgery
We place electrodes in one or both sides of the brain in a small region called the globus pallidus pars interna (GPi). You’ll be under intravenous (IV) anesthesia for this procedure. That’s so we can wake you up during parts of the procedure and judge your responses to brain stimulation. You’ll get medication for discomfort or anxiety, if you choose.
An electrophysiologist performs the electrical recording and stimulation of your brain. The goal is to precisely identify and map out the surgical target. The team may ask you to perform some simple motor or cognitive tasks so we can identify the best location to place the electrode.
After mapping the brain, the surgeon places a permanent, stimulating electrode within the globus pallidus. If you’re having bilateral surgery, we repeat the same procedure on the other side of your brain.
The procedure takes about four to five hours. After surgery, we’ll perform a CT or MRI scan. You will spend one or two nights in the hospital after this surgery.
Get details on what to expect during your hospital stay.
Stage 2: Outpatient Surgery
Both stages of DBS surgery may take place in one day. In some cases, the neurosurgeon decides to wait before proceeding with the second stage. In that case, you will return about one week later for the second stage.
The second stage is an outpatient procedure, meaning you’ll return home after the procedure. You’ll be under general anesthesia (fully asleep).
The surgeon will place one or two pulse generators (batteries) under the skin of your chest. The pulse generator will connect to the brain electrode by an extension wire. This wire runs under the skin from the top of the head and behind your ear to the pulse generator.
The pulse generator will not be visible. This procedure takes one to two hours.
Stage 3: Doctor’s Office Visit
Several weeks later, you return to see your doctor who will turn on the pulse generators. These begin to activate the electrodes in your brain.
You may have what we call a “honeymoon period” right after surgery. This can occur even before we turn the electrodes on. This improvement is a temporary effect that we sometimes see when we place the electrodes in the brain. After several weeks, symptoms return.
Once we turn on and properly adjust the electrodes, symptoms will improve again. Remember, this process can take several months.
Unfortunately, we can’t yet cure or stop the progression of dystonia. Keep these facts in mind:
- Even if the treatment works well, you may continue to have good and bad days.
- Just as you have ups and downs with medications, you will have ups and downs with the functioning of your stimulator.
- If your symptoms reappear or worsen, we’ll work closely with you to help you get through these rough periods.
Learn more about what to expect after DBS surgery.
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