Deep Brain Stimulation at Jaslok

Deep Brain Stimulation (DBS) is a minimally invasive neurosurgical procedure that has proven to be an effective treatment for the following conditions: Parkinson's Parkinson's Disease, Essential Tremor, Dystonia, Tourette Syndrome. Further illnesses can be treated after critical examination by the deep brain stimulation: Chronic pain syndromes, therapy-refractory compulsive diseases, therapy-refractory depressions, therapy-refractory anxiety disorders, and epilepsy.

What is meant by deep brain stimulation? (Deep Brain Stimulation at Jaslok)
Deep Brain Stimulation (DBS) is a minimally invasive neurosurgical procedure in which patients are placed with high precision fine electrodes in the brain to electrically stimulate a circumscribed central area in the brain.

This pathological signal changes that disturb a normal brain function are eliminated and significantly improved the complaints of patients. In its modern form, this surgical technique has been used internationally for almost 30 years and has long been accepted as a treatment modality in clinical routine.

The deep brain stimulation requires a high level of competence of the medical staff and a large interdisciplinary expert knowledge.

Eligible patients are considered together from the neurosurgical, neurological, psychiatric and anesthesiological point of view, and appropriate operations are recommended. The surgical procedures are performed according to the latest medical knowledge using state-of-the-art imaging techniques and the highest possible safety standards.

What applications are there in deep brain stimulation? (Deep Brain Stimulation at Jaslok)
DBS has proven to be an effective treatment for many diseases. The following diseases are routinely treated successfully by deep brain stimulation:

 Idiopathic Parkinson's syndrome (Parkinson's disease)
 Essential tremor
 dystonia
 Tourette's syndrome

The following diseases can be treated after critical examination by the deep brain stimulation:

 Chronic pain syndromes
 Therapy-refractory obsessive-compulsive disorder
 Therapy refractory depression
 Therapy Refractory Anxiety Disorders
 epilepsy

How is the deep brain stimulation done? (Deep Brain Stimulation at Jaslok)
Before the operation is performed, patients in Jaslok receive an indication test to determine the extent to which deep brain stimulation can alleviate individual discomfort and which risk factors exist. At the same time, the prospects of success are critically scrutinized by different experts from different disciplines.

Subsequently, the affected patients are summoned and presented in joint consultation. Here patients have the opportunity to ask questions again and to discuss the surgical procedure.

Immediately prior to the operation, a high-resolution magnetic resonance imaging (MRI) of the brain is performed (possibly under brief anesthesia) with special sequences that not only display the necessary core areas with high precision but can also display specific pathways between different brain areas. This MRI is used for the concrete planning of the intervention.

The surgery itself can be performed under local anesthesia or under general anesthesia. Both methods are equivalent but contain specific advantages and disadvantages. The decision on how to perform an operation is always critically shared with the patient. The surgery always uses a dedicated surgical team to ensure the highest level of patient safety in this highly complex procedure.

The surgery begins by placing a stereotactic frame on the head under local anesthesia (or under general anesthesia) followed by computerized tomography (CT). In this way, together with the MRI, a three-dimensional coordinate system can be created, which allows an exact determination of the entry and destination point of the electrodes. The accuracy is in a range of less than one millimeter.

In the operating room, the head is first shaved, disinfected and covered under sterile conditions.

After the minimal opening of the bony skull, fine microelectrodes are introduced into the target area of ​​the brain and the brain waves are registered and evaluated. With the help of the neurologist, a test stimulation is then carried out in awake patients in order to ensure an optimal position of the electrodes.

It is tested for desired effects and side effects. Once the optimal position of the electrodes has been determined, the microelectrodes are removed and the final electrodes carefully implanted to the nearest millimeter and fixed to the skull bone.

Finally, a CT examination and the implantation of the extension cable and the stimulator (under general anesthesia). This includes i.a. various chargeable and non-chargeable systems and a wide variety of stimulation probes including directional probes, which allow a targeted alignment of the electric field. After extensive consultation, the patient may decide for himself on the implant, the exact implantation site and the surgical procedure in local anesthesia or under general anesthesia.

The patient is then monitored for a few days on the normal ward and discharged into the home after a total of 10 days. The stimulator is initially switched off to ensure undisturbed healing of the probes. After about 6-8 weeks the stimulator will be programmed step by step and carefully over a few days in the clinic for neurology as part of a stationary stay. The stimulation parameters are adjusted to the optimal treatment of the symptoms and the medication is reduced.

During the outpatient procedure, the patients at Jaslok are regularly examined by specialists and the stimulation parameters are adjusted if necessary.

What chances of success and risks does deep brain stimulation have? (Deep Brain Stimulation at Jaslok)
The deep brain stimulation is a modern and internationally established surgical procedure and is considered to be very low risk (complication rate of 1-3%) with very high chances of success (80-90%). Numerous international studies have demonstrated the effectiveness and safety of this treatment. Although the underlying diseases are not cured, the resulting complaints significantly and persistently alleviated, so that the quality of life of the affected patients significantly improved.

Which alternatives are there for deep brain stimulation? (Deep Brain Stimulation at Jaslok)
In principle, drug therapy is attempted before an operative treatment. With increasing failure and/or relevant side effects, deep brain stimulation may be considered. Alternatively, it is also possible to use lesional methods which, in contrast to deep brain stimulation, are not reversible.

Author's Bio: 

Deep Brain Stimulation is a very effective treatment modality for problems such as Tremors, Multiple Sclerosis, Parkinson’s disease, and stiffness by using electric stimulation.

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