Deep Brain Stimulation
Deep brain stimulation (DBS) with PerceptTM PC device by Medtronic
What Is Deep Brain Stimulation?
Deep brain stimulation (DBS) is
- A device used to help control seizures. Surgery is done to place the device, then it is programmed in the outpatient clinic by an epilepsy specialist.
- A type of neuromodulation therapy. This means, DBS therapy is designed to change (modulate) how brain cells or networks work by giving electrical stimulation to brain areas involved in seizures.
- Used together with seizure medications.
DBS therapy for the treatment of seizures was approved by the U.S. Food and Drug Administration (FDA) in 2018. It has been approved in Europe, Australia, and Canada for several years.
DBS therapy targeting other areas of the brain is approved by FDA to treat other neurologic conditions, including Parkinson’s disease, Essential Tremor, Dystonia and Obsessive-Compulsive Disorder.
Who Can Use DBS?
- DBS may be used to treat people 18 years and older with uncontrolled focal seizures when medicines alone don’t work. Uncontrolled seizures, also called drug resistant seizures, are seizures that do not respond to appropriate trials of seizure medicines.
- DBS is an option for people whose seizures are not able to be treated with other types of epilepsy surgery which are aimed to cure some forms of epilepsy.
How Does DBS Work?
The DBS device is placed by a neurosurgeon during a procedure. Thin wires (called electrodes) carry electrical impulses from the neurostimulator device directly to the brain to stop brain signals that causes seizures.
- The neurostimulator device is battery operated. It can be programmed like a tiny computer (similar to a cardiac pacemaker).
- The device is programmed by your doctor or nurse to deliver electrical currents. The stimulation is delivered in a preset cycle and not directly in response to a seizure.
- These electrical currents affect the excitability of certain circuits of the brain and help prevent seizures or reduce their frequency.
- It can also capture and report information from the brain which can help the epilepsy care team to make other treatment decisions.
How Helpful Is DBS?
DBS does not cure epilepsy but can decrease the number and severity of seizures in many people. In general, results of clinical studies show
- About half of people who have DBS have less seizures with this treatment.
- For others, DBS therapy may reduce seizure severity.
- The positive effect of DBS therapy may not be seen right away. As with other neuromodulation devices, it can take time for DBS therapy to show its full benefit.
- Many patients have increased improvement of their seizures over time.
- DBS is always used together with seizure medication. Like other devices used to treat epilepsy, if seizure control improves with DBS, seizure medicines may be lowered to lessen side effects.
How Do I Know If I Am A Candidate For Deep Brain Stimulation?
Everyone who has seizures that are not well controlled after trying two or more antiseizure medications should talk with their epilepsy doctor about whether treatment with a device or surgical removal of the seizure focus could help them. An epilepsy specialist or an evaluation at an epilepsy center can help you explore all treatment options.
- Determining if a person may benefit from DBS therapy starts with a number of diagnostic tests to see if any type of surgery or device could help. If a person cannot have surgery to remove the area of brain causing the seizures, then a device such as responsive neurostimulation (RNS), vagus nerve stimulation (VNS), or Deep Brain Stimulation (DBS) may be considered.
- Testing for DBS therapy takes into consideration:
- Some tests are done in the outpatient setting. For other tests, people are admitted to an epilepsy monitoring unit (EMU) at a comprehensive epilepsy center. The testing will involve video EEG (electroencephalogram) monitoring, MRI (magnetic resonance imaging) or other imaging tests, and cognitive neuropsychology testing. Other tests may be needed depending on the person’s situation.
- Although the testing can feel like it is taking a long time, careful evaluation is important to choose the best approach. This time gives you a chance to ask your epilepsy team questions and share any concerns about DBS therapy.
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