Deep brain stimulation for the treatment of epilepsy in Türkiye

Deep brain stimulation and epilepsy (DBS) is a surgical procedure based on implanting electrodes in specific areas of the brain that generate electrical impulses that control abnormal brain activity. The impulses can be modified according to chemical differences within the brain that cause different pathological conditions and are controlled through a pulse generator. The programmable procedure is placed under the skin in the upper chest.

The deep brain stimulation system has three components:

• Electrode: A thin, insulated wire is inserted through a small hole in the skull and implanted in a specific area of the brain.
• Extension cord: connects the electrode to the internal pulse generator and is passed in isolation under the skin of the head, neck and shoulder.
• IPG Internal Pulse Generator: These are implanted under the skin in the upper chest.

How does deep brain stimulation therapy work?

• The device is placed by a neurosurgeon during an operation. Thin electrodes deliver electrical pulses from the neurostimulator directly to the brain to stop brain signals that cause seizures.
• The neurostimulator is battery operated and programmable like a minicomputer (like a pacemaker).
• The doctor programs the device based on previous analyzes and not in direct response to a seizure.
• These electrical currents affect the excitability of certain circuits in the brain and help prevent seizures or reduce their frequency.

What is epilepsy

Epilepsy is a disorder of the central nervous system, where the brain is in a state of abnormal activity, which leads to seizures, behavior, unusual sensations, and loss of consciousness in some patients. The disease affects males and females of all genders, races, and ages.

Treatment with medication leads to control of seizures for most people with epilepsy, and some people need lifelong treatment, and seizures may eventually go away, but if this doesn’t work, deep brain stimulation may be another treatment.

What are the symptoms of epilepsy?

Abnormal activity in the brain affects any brain process. Symptoms vary according to the type of seizure, and the patient has the same type of seizure each time. Signs and symptoms of a seizure may include the following:

• confusion.
• Gazing.
• Trembling uncontrollably in the arms and legs.
• Loss of consciousness or awareness.
• Psychological symptoms such as fear, anxiety or déjà vu.

How useful is deep brain stimulation for patients with epilepsy?

Deep brain stimulation does not cure epilepsy, but it can reduce the number and severity of seizures in many cases. Results of clinical studies show the following:

• Problems and symptoms decreased in half of the people who had the device.
• For others, treatment reduces the severity of attacks, problems, and symptoms.
• The positive effect of treatment is not seen immediately and it may take some time to show its full benefit.
• Patients’ seizures, problems, and symptoms improved over time.
• Medication doses are reduced to reduce side effects if disease control improves.
• The device is used alongside other medicines.

Who is a Candidate for Deep Brain Stimulation?

He resorts to treatment after trying pharmacological treatments on patients, such as anti-seizure drugs, depression drugs, and drugs for Parkinson’s patients and multiple sclerosis, and then he consults the doctor about the success rates of deep brain stimulation.

Pre-operative deep brain stimulation and epilepsy test:

The extent of benefit from treatment is determined by conducting a number of diagnostic tests and all surgical options are taken into account. VNS), or deep brain stimulation (DBS).

Consider these factors when choosing deep brain stimulation treatment:

• The type of person’s symptoms.
• The best way to reduce the risks of surgery and get the most out of deep brain stimulation.

Before surgery:

• The patient gives his medical history including allergies, medications, anesthesia reactions, and previous surgeries.
• Stop taking all nonsteroidal anti-inflammatory drugs (IBUPROFEN, NAPROXEN) as well as blood thinners (COUMADIN, ASPIRIN, PLAVIX) seven days before surgery.
• Not drinking alcohol and using nicotine one week before and two weeks after surgery, in order to avoid bleeding and problems with the healing process.
• It is required to wash skin and hair with Hibiclens or a special soap prior to surgery.
• No food or drink is allowed the night before the surgery.

During surgery:

The whole process takes 5 to 7 hours. The surgery takes 3 to 4 hours, and the first step begins with placing a stereotaxic frame on the patient’s head temporarily using Velcro Straps. The four pin sites are injected with local anesthesia, then a mild sedative is administered. One inch wide hair is shaved along the incision line. A skin incision is made across the top of the head, and two holes are opened on the left and right sides of the skull using a drill, through which an electrode enters the brain to a specific and planned location inside the brain.

After that, a number of tests are conducted, such as raising the arms or legs, or counting numbers, and the brain cell activity is displayed on the computer and the exact location of the neurons is determined. Then a plastic cover is placed over the hole to fix the electrode in place, and a file of wire is left under the scalp to tie it later. With an extension cord and a stimulator, the scalp incision is finally closed with sutures and a bandage is placed on it.

after surgery

The patient stays in the hospital for monitoring and observation, then returns home the next day, then returns to the hospital after about a week to undergo surgery to implant the stimulator in the chest. The surgery is performed under general anesthesia and takes about an hour. Patients return home on the same day.

Stimulator implantation surgery

Part of the scalp incision is reopened to access the electrical leads, then a small incision is made near the collarbone, the neurostimulator device is implanted under the skin, and then connected to an extension cord that is passed under the skin of the scalp down the neck and then to the stimulator in the chest

Catalyst programming:

The stimulator is programmed about 10 days after surgery and the drug dose is adjusted accordingly. It is reprogrammed through 3 to 4 sessions every 3 weeks to achieve maximum symptom control while minimizing side effects. Most people do not feel the stimulus because it reduces their symptoms, but some people may feel a short sensation. Tingling when you turn on the catalyst for the first time

Risks

The treatment has potential but minor and reversible risks and side effects, and deep brain stimulation is safe and effective in properly selected patients.

Risks include:

• The risk of cerebral hemorrhage, including stroke, is 1%.
• infection.
• A malfunction in the machine.
• No benefit for certain symptoms.
• headache.
• Deterioration of mental or emotional condition.

Side effects during stimulation include:

• Temporary tingling in the face or extremities.
• A feeling of tightness in the muscles.
• Speech or vision problems.
• Loss of balance.

treatment in Türkiye

The medical staff of surgical teams, doctors and consultants in REHABTÜRK offer the best treatment options and free consultations – by striving to keep abreast of the latest medical technologies and methods.

Ask for a free consultation.