DBS for Movement Disorders
Deep Brain Stimulation (DBS) is a precise surgical procedure used to treat resistant movement disorders, such as dystonia, by implanting a device that regulates abnormal brain signals.
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Deep brain stimulation is a surgical procedure used to help control symptoms of neurological movement disorders that are resistant to medication or other treatments, including essential tremor, Parkinson's disease, and dystonia.
This procedure involves implanting a pacemaker-like device in the brain to interrupt the irregular electrical signals that cause movement symptoms. These electrical impulses are controlled by an electrical generator implanted under the chest.
What is dystonia?
• Dystonia is a movement disorder that causes involuntary muscle spasms and contractions. Movement disorders are neurological disorders that occur when changes in the nervous system affect how muscles contract. In dystonia, areas of the brain responsible for muscle movement, such as the basal ganglia, which coordinate muscles, are affected, resulting in partial muscle contraction.
• The causes of dystonia vary and include inherited genetic mutations, environmental factors such as infections or medications, or even unknown reasons.
• The primary symptoms of dystonia are slow, irregular muscle movements that worsen with activity and may be accompanied by pain. They may also cause abnormal postures, such as tilting the head to one side or raising one shoulder. The irregular movements may vary depending on the affected muscle.
• Symptoms of dystonia vary depending on the affected part of the body and may be limited to one area or involve the entire body. For example, a person with dystonia in the leg or foot may experience cramping or foot drop, where the leg is pulled, while hand dystonia can lead to gradual deterioration of handwriting, and sometimes tremors, speech difficulties, involuntary blinking of the eyes, or neck rotation.
• Dystonia is diagnosed by a medical examination, genetic testing for hereditary causes, MRI scans, and other tests to rule out other causes of movement impairment.
• Treatments for dystonia focus on controlling its symptoms, as there is no cure. This is done through medications and physical therapy. If necessary, Dr. Zeiad Yossry performs deep brain stimulation surgery.
• Cervical dystonia is a type of dystonia caused by involuntary contractions of the neck muscles, leading to abnormal head movements and postures. There is no cure for cervical dystonia, but deep brain stimulation can help control symptoms and improve daily functioning.
Components of deep brain stimulation:
During deep brain stimulation surgery, Dr. Zeiad Yossry, professor of neurosurgery and Parkinson's disease, implants three components:
• Electrodes are gently placed in brain tissue through small openings in the skull.
• Extension wires pass through the head and neck to connect the electrodes to the neurostimulator.
• A neurostimulator is a small device similar to a pacemaker that the surgeon implants under the skin of the upper chest.
How does deep brain stimulation work?
Deep brain stimulation (DBS) provides electrical stimulation to the brain to regulate its activity, much like a pacemaker does for the heart. The technology's success stems from the fact that many movement symptoms are caused by dysfunctional brain networks, and electrical stimulation of specific locations in those networks can restore normal function.
What are the uses of deep brain stimulation?
Deep brain stimulation is a valuable treatment for people with movement disorder symptoms, such as:
• Parkinson's disease, a progressive neurological disorder causing tremor, stiffness, and slowed movements.
• Dystonia, involuntary muscle contractions that force certain parts of your body into irregular positions.
• Essential tremor, an involuntary shaking of one or more parts of the body, usually affecting the arms or hands.
However, deep brain stimulation (DBS) is not a first-line treatment and is usually reserved for patients who meet specific criteria and have tried other treatments without success.
Deep brain stimulation is a relatively new procedure, and researchers are also exploring DBS for psychiatric conditions, including depression and obsessive-compulsive disorder.
Why choose DBS, and are you the ideal candidate?
Deep brain stimulation is a surgical procedure, so it's not the ideal treatment when other, more conservative treatments are available. However, it has proven effective in cases where the condition doesn't respond to medications or other treatment options, or where side effects affect quality of life.
Deep brain stimulation (DBS) does not cure neurological or psychiatric conditions, and it may not completely eliminate symptoms. However, it can significantly reduce symptoms and improve the patient’s quality of life.
Benefits of Deep Brain Stimulation (DBS) Surgery:
• Long-term relief: DBS can provide lasting symptom relief and improve quality of life.
• Adjustable settings: The device can be fine-tuned to optimize stimulation for the patient’s needs.
• Reversible procedure: The implants can be removed in a future procedure if necessary.
Steps of deep brain stimulation surgery:
You will undergo a comprehensive evaluation by Dr. Zeiad Yossry’s team, including a neurological examination, CT or MRI scan, neuropsychological testing, and other assessments. This evaluation determines if deep brain stimulation is appropriate for you and identifies the best brain sites for stimulation. Typically, Dr. Zeiad Yossry implants electrodes on both sides of the brain to control symptoms on both sides of your body. Sometimes, he only uses electrodes on one side of your brain. This evaluation also allows the team to understand your symptoms and goals and answer any questions you may have.
What to expect during deep brain stimulation?
Deep brain stimulation (DBS) involves two separate surgical procedures: implanting electrodes in the brain and then implanting a neurostimulator in the upper chest.
Electrode Placement:
1. Dr. Zeiad Yossry numbs your scalp. Depending on the type of procedure, you may receive a sedative to keep you relaxed and awake during the procedure, or you may be fully anesthetized.
2. Dr. Zeiad Yossry makes a small incision about 2.5 cm long on one or both sides of your head to insert the electrodes.
3. Dr. Zeiad Yossry uses advanced technology during wire insertion, allowing him to precisely locate the wire in the brain.
4. Dr. Zeiad Yossry moves your arms and legs, and the medical team monitors the response of your brain cells to test the stimulation and check for any side effects. This ensures that the electrodes are positioned correctly to improve symptom control while minimizing side effects.
5. Dr. Zeiad Yossry places the back end of the wires behind your ear, under the scalp.
6. Implanting the electrodes on both sides of the brain takes approximately two to three hours. If the electrodes are placed on only one side of the brain, the surgery takes a shorter time.
7. You will spend one night in the hospital after electrode placement.
Neurostimulator Implantation:
This procedure usually occurs a few days to a few weeks after the first step.
1. You will be under general anesthesia.
2. Dr. Zeiad Yossry makes an incision near your collarbone and places the generator in the upper chest.
3. The surgeon makes another incision behind your ear where he inserts the back end of the wire. Extension wires are then implanted that pass under the skin of your neck and scalp to connect the generator to the electrodes in your brain.
4. The implantation of the neurostimulator usually takes about 30 minutes, and you can go home the same day.
What happens after deep brain stimulation (DBS) surgery?
You will return to Dr. Zeiad Yossry's office approximately one month after surgery to begin your DBS programming visits. During these visits, Dr. Zeiad Yossry will evaluate you and program the neurostimulator, monitoring your movements to help determine the correct settings and stimulation intensity.
You will continue follow-up visits to fine-tune the stimulator settings. Over time, Dr. Zeiad Yossry may reduce your medication dosage.
Life with Deep Brain Stimulation:
DBS implantation helps you live a more active and fulfilling life. Many sports and physical activities become easier after recovery. Once surgical sites have healed, you can resume normal activities, including exercise and bathing.
Deep brain stimulation improves symptoms of movement disorders when other treatments fail. Thanks to the expertise of Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, patients with dystonia can achieve significant improvements in their quality of life.
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