Deep Brain Stimulation (DBS)
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Deep Brain Stimulation (DBS)
Deep brain stimulation (DBS) is an advanced medical procedure that helps treat Parkinson's disease with the highest success rates, by sending electrical impulses to stimulate neurons in the brain.
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DBS is a medical procedure that involves delivering a mild electrical current to a specific part of the brain by implanting electrodes. These electrical signals control the dysfunctional signals that cause dopamine deficiency and, consequently, Parkinson's disease Deep brain stimulation has helped treat many patients with Parkinson's disease, improving their lives significantly with the expertise of top neurosurgeon Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease. The current reaches the brain through one or more wires connected to a pulse generator; a small device implanted under the skin near the collarbone.
Who needs deep brain stimulation?
Deep brain stimulation treats conditions that affect how neurons—a key type of brain cell—function. When neurons don't function properly, it affects the abilities they control. Depending on the severity of the problem, neurons may partially or completely lose these abilities.
Why is deep brain stimulation used?
There are billions of neurons in each human brain. These cells communicate with each other through electrical and chemical signals. Various brain conditions can cause neurons in specific areas less active, causing those areas to function poorly. Depending on the affected part of the brain, different abilities may be disrupted.
DBS uses an artificial electrical current to make these neurons more active, helping to relieve symptoms of several brain-related conditions.
What conditions and symptoms can DBS treat?
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, treats a wide range of brain conditions through deep brain stimulation. The FDA has approved DBS for the following conditions:
• Dystonia (muscle contractions).
• Parkinson’s disease (especially when symptoms worsen and medications become less effective).
What happens before DBS surgery?
After confirming that the patient is a suitable candidate for DBS in consultation with neurologists, Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, discusses key details of implanting a deep brain stimulator device. He will also confirm the feasibility of this surgery through imaging tests or laboratory tests.
High-resolution MRI is one of the most important diagnostic tools, allowing direct targeting of the nuclei for electrode implantation. The appropriate nucleus for electrode implantation is selected based on several factors, including the nature of the symptoms, the disease itself, and the nucleus shape in imaging. The path for the electrode to reach the nucleus is also planned to ensure a safe route, precise electrode placement, and active contact points inside the target nuclei for maximum patient benefit.
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, will also discuss the following with you:
• Medications you are taking: Your doctor may ask you to stop taking certain medications (such as blood thinners) before the procedure.
• Fasting: Since this surgery requires general anesthesia, Dr. Zeiad Yossry will ask you to fast— no solid food for at least 8 hours and no liquids for at least 2 hours before the procedure.
What happens during deep brain stimulation (DBS)?
This procedure involves two stages. The first stage involves inserting stimulating electrodes into each side of the brain, and the second stage involves implanting the stimulating battery—known as a pulse generator—under the skin of the upper chest.
Stage 1: Placing the stimulation electrodes:
This stage usually begins with shaving the scalp hair and securing the head in a special frame to keep it steady. This is done while you are under anesthesia.
1. Once the frame is in place, a CT scan is performed during surgery to capture images of the brain and determine the electrode path.
2. Once the CT scan is complete, the entry point is identified and the head is surgically sterilized.
3. Then a local anesthetic is injected to numb the scalp and skull in that area.
4. Then, Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, makes a small incision in the skull bone to insert the electrodes.
5. Depending on the reason for the surgery, you may be awakened for awake tests, especially for movement disorders. If awake, you may feel vibrations but no pain during electrode insertion.
6. During the placement of the wires, you may be asked to answer questions, read, look at pictures, or move your arms, legs, hands, and feet in certain ways. This helps ensure the electrodes are positioned correctly. Another CT scan is performed to confirm precise placement.
7. The number and position of electrodes depend on your condition. Some patients may have only one electrode, while others may have several on one or both sides of the head. Once the electrodes are placed, the electrode tips are protected with a plastic cap and threaded under the skin to the back of the head. The incisions are then cleaned and closed.
Step 2: Placing the pulse generator:
This stage is performed under general anesthesia, so you will be asleep and feel no pain or discomfort.
1. Dr. Zeiad Yossry makes a small incision in the skin below the collarbone, creating a small pocket-like space under the skin to house the pulse generator.
2. Then he inserts an extended wire that passes between the outer skull area and the skin surface.
3. The surgeon guides the wire down until the far end is under the skin near the collarbone in the generator pocket.
4. He then connects one end of the extended wire to the electrodes and the other end to the pulse generator. The pulse generator is then placed in the pocket-like space, and the incision is closed.
What happens after deep brain stimulation (DBS)?
A follow-up appointment will be scheduled within a few weeks of the procedure to begin programming the pulse generator. All current pulse generators have a built-in wireless antenna, allowing Dr. Zeiad Yossry to access and program the device externally.
Most pulse generators use long-lasting batteries that typically last between three and five years. Some devices use rechargeable batteries, which can last about nine years. Replacing the battery also requires a surgical procedure, but it is usually shorter and simpler than the original surgery.
What are the benefits of deep brain stimulation (DBS)?
• A treatment option when medications are ineffective: DBS is considered when medications stop working or lose effectiveness. In Parkinson's disease, medications lose their effect over time, necessitating higher doses and leading to side effects. With deep brain stimulation, lower doses of medications often become effective again, meaning your symptoms are under control with fewer side effects.
• Life-changing or even life-saving treatment: Some conditions cause severe symptoms that prevent even basic daily activities. DBS can improve these symptoms and significantly enhance the quality of life.
• Adjustable and reversible: The surgeon can adjust the pulse generator settings to suit your needs. The wires and pulse generator can also be removed during a subsequent surgery if necessary.
How long is the recovery period?
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, explains what to expect regarding your recovery time, when you may notice changes in your symptoms, and how you feel. He can give you an estimate of your recovery time, which may vary depending on your overall health, other conditions, and personal circumstances.
Most people need to stay in the hospital for one day after surgery. Recovery time generally takes several weeks. Dr. Zeiad Yossry will likely ask you to:
• Avoid any physical activity for about two weeks after the procedure: This includes simple tasks like housework or sexual intercourse. You should not lift anything heavier than 2.25 kilograms.
• Avoid moderate or high-intensity activities for at least 4 to 6 weeks: This includes exercise and physical work. Most people can return to work or resume their normal routine after this period.
• Be careful when moving or stretching: Certain movements, such as raising your hands above your head, should be avoided for several days after surgery. Dr. Zeiad Yossry will advise you on how long you will need to limit these movements.
How should I care for the surgical site after returning home?
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, provides you with instructions on how to care for the surgical sites, including the following:
• Any stitches or staples will be removed about 10 to 14 days after surgery.
• The stapled areas on your head should remain covered with bandages until they are dry. You should also change the bandages at least once daily.
• Bandages can be removed two days after surgery.
• At this point, you can take a shower - just let the water flow gently over your head and don't rub.
• You can use baby shampoo on your hair. Pat the area gently to dry—do not rub.
• Do not scratch around the wound, as this may damage it or cause infection.
What is the importance of the follow-up period?
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, schedules post-procedure consultations. Programming visits aim to find the appropriate settings that work best without causing disruptive side effects.
Regular follow-ups also aim to monitor your condition and symptoms and adjust medications or other treatments as needed.
What is the success rate of deep brain stimulation (DBS)?
In general, deep brain stimulation is usually successful, especially with top-notch physician Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease. The success rate depends on the condition being treated. In cases such as dystonia and Parkinson’s disease, DBS is highly effective.
Can I use electrical and electronic devices if I have implanted DBS devices?
In general, electronic and household devices do not cause problems with the pulse generator. If interference occurs, the most likely effect is that the pulse generator will turn off. This may not have an immediate impact, but sometimes you may notice your symptoms worsening or feel uncomfortable.
Overall, you should keep the following in mind:
• Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, provides two key items you should always keep close: an identification card and a programmer device. The ID card helps in situations involving certain electronic devices, such as metal detectors or anti-theft scanners. The patient programmer allows you to turn the device on and off and adjust stimulation settings if needed.
• Household appliances, such as microwaves, computers, smartphones, and other common electronic devices, do not cause any kind of interference or problems with your pulse generator.
• Having one or more stimulating wires and an implanted pulse generator means you cannot undergo certain medical and diagnostic procedures, such as MRI, transcranial magnetic stimulation, and thermotherapy.
Does deep brain stimulation cure the conditions it is used for?
Deep brain stimulation does not cure the underlying conditions; it alleviates their symptoms, as these conditions are chronic and cannot be cured.
Will I still need to take medication after DBS?
Depending on the condition, it may be possible to reduce medication. However, deep brain stimulation is most beneficial when combined with medications and other treatments. This combined approach often allows for lower drug doses, fewer side effects while still achieving the same benefits.
Deep brain stimulation (DBS) represents a revolution in treating movement disorders, providing precise symptom control without the need for high medication doses. With the expertise of Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, this procedure is performed using the latest technologies to ensure the best results with minimal complications, offering patients a better, more comfortable, and independent life.
Public FAQs
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, recommends deep brain stimulation when it is likely to provide significant benefit with the least risk of side effects or complications. Four main factors determine whether a Parkinson’s patient is suitable for DBS:
1- Diagnosed with Parkinson's disease for at least four years:
Deep brain stimulation is approved by the FDA for individuals who have been diagnosed with Parkinson's disease for at least four years. Beyond that, there are no hard and fast rules because each person's symptoms and course are different.
However, there are indications that may point to deep brain stimulation. A person may be a good candidate, for example, if he has a good response to levodopa and are still physically active, but is experiencing problems with the duration of the medication's effect or with dyskinesia.
Many experts believe it is best to postpone deep brain stimulation if motor symptoms, such as tremor, slowness, and stiffness, are adequately controlled and medications do not cause intolerable side effects. On the other hand, deep brain stimulation should be considered promptly before balance problems or significant cognitive decline develop, as these symptoms are unresponsive to deep brain stimulation and may eliminate any potential benefit.
2- Symptoms improve with levodopa, but complications occur:
Over time, many patients continue to respond to levodopa but experience complications or side effects that affect their quality of life. For example, the medication may only work for short periods, requiring doses every 2–3 hours. Alternatively, the patient may experience fluctuations throughout the day, with no predictable duration of the medication's effectiveness, making the patient unable to function normally due to the limited effectiveness of the medication.
In general, deep brain stimulation achieves the same maximum efficacy as levodopa. For this reason, some doctors call DBS "electric levodopa." However, DBS outperforms levodopa by providing a smoother, more consistent symptom control throughout the day, and it can successfully manage tremors that do not improve with levodopa or other medications.
3- No major memory or cognitive issues:
DBS may temporarily worsen memory and cognitive problems, but in rare cases, it may be permanent. Patients with significant memory and thinking difficulties are at higher risk of worsening their condition after surgery.
For this reason, all potential DBS candidates undergo memory and neurocognitive testing as part of the evaluation. If results are within the normal range, the patient is considered eligible.
4- Generally good overall health:
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, considers a patient's overall health and fitness for surgery when evaluating him for deep brain stimulation.
Certain conditions, such as heart disease, blood pressure issues, clotting disorders, or other medical problems, can make the procedure riskier.
There is no absolute age limit for deep brain stimulation. You might think that patients over 70 may not always respond as strongly as younger individuals. However, other factors, such as Parkinson's disease symptoms, levodopa response, memory, cognition, and other health conditions, may be more important than age alone.
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, uses deep brain stimulation (DBS) for certain cases of Parkinson’s to control symptoms that cannot be adequately managed with medication. Parkinson's disease is treated by applying high-frequency stimulation (greater than 100 Hz) to targeted areas deep within the brain.
DBS is recommended for people with Parkinson’s disease who experience motor fluctuations and tremors that are not adequately controlled with medication, or for those who cannot tolerate medication.
Four brain regions are targeted with neurostimulators in Parkinson’s disease, aiming to achieve one of the following:
1. DBS has been shown to reduce uncontrollable movements called dyskinesia, which can sometimes allow patients to take adequate doses of medication (especially levodopa), resulting in better symptom control.
2. DBS has a rapid and profound effect on tremors. Studies also show that DBS may reduce the need for dopaminergic medications.
3. DBS is more commonly performed in tremor-dominant types of Parkinson's disease.
4. Some studies have indicated the effectiveness of DBS in reducing freezing of gait.
Selecting the correct DBS target is a complex process that requires the expertise of Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease. Factors influencing target selection include identifying the most bothersome symptoms, the patient's current levodopa dosage, the effects of current medications, and coexisting medical problems.
Deep brain stimulation (DBS) can improve the following symptoms:
• bradykinesia.
• Stiffness.
• Tremors.
• Off periods when medications stop working effectively.
• Involuntary movements caused by levodopa (dyskinesias).
• Freezing gait (feet sticking to the ground).
• Toe bending and foot turning inward.
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