Deep Brain Stimulation (DBS) in the treatment of multiple sclerosis

Deep Brain Stimulation (DBS) is a surgical procedure that involves implanting electrodes in specific areas of the brain These electrodes generate electrical pulses that modulate abnormal brain activity, which can be adjusted to treat various medical conditions. The pulses are controlled by an internally programmable pulse generator, which is placed under the skin in the upper chest.

The Deep Brain Stimulation system consists of three components:

• Electrode: A thin insulated wire that is inserted through a small opening in the skull and implanted in a specific area of the brain.
• Extension wire: Connects the electrode to the internal pulse generator and is routed under the skin of the head, neck, and shoulder.
• Internal Pulse Generator (IPG): Implanted under the skin in the upper chest.

How does Deep Brain Stimulation therapy work?

• The device is implanted by a neurosurgeon during a surgical procedure, and the thin electrical electrodes deliver electrical pulses directly to the brain from the neurostimulator device, aiming to halt the brain signals that cause seizures.
• The neurostimulator is a battery-powered, programmable device that is similar to a small computer or a pacemaker.
• The doctor programs the device based on the patient’s individual needs, not in response to specific seizures.
• These electrical currents affect specific circuits in the brain and help prevent or reduce the frequency of seizures.

What is Multiple Sclerosis (MS)?

Multiple Sclerosis (MS) is a disease that results in damage to the central nervous system, which consists of the brain and spinal cord. In MS, the immune system attacks the protective myelin sheath surrounding the nerve fibers, causing damage to those cells and disrupting nerve signals and communication between the brain, spinal cord, and other parts of the body.

Symptoms of Multiple Sclerosis:

Symptoms and signs of MS vary widely from person to person and the affected locations, but many patients experience impaired motor abilities, such as:

• Peripheral or bilateral limb numbness occurring in the legs or trunk.
• Feeling an electric shock accompanying a specific movement, such as bending the neck forward.
• Unsteady gait and tremors.

Many MS patients also experience vision problems, including:

• Partial or complete loss of vision, which may be accompanied by pain during eye movement.
• Double vision.
• Blurred vision.

Other symptoms of MS include:

• Unclear speech.
• Fatigue and dizziness.
• Tingling or pain in various parts of the body.
• Problems with sexual function, bowel, and bladder.

How beneficial is Deep Brain Stimulation for Multiple Sclerosis patients?

Deep Brain Stimulation (DBS) is primarily used to control severe tremors associated with Multiple Sclerosis. However, DBS will not help solve other problems related to the disease, such as vision loss, sensory loss, or weakness, nor will it treat or prevent disease progression.

Who is a candidate for Deep Brain Stimulation and Multiple Sclerosis?

Patients turn to DBS treatment after trying medications such as anticonvulsants, antidepressants,
Parkinson’s drugs, and multiple sclerosis drugs.

Afterward, consultation with a doctor is necessary to discuss the success rates of deep brain stimulation.

Preoperative testing for Deep Brain Stimulation and Multiple Sclerosis:

The benefit of the treatment is determined through diagnostic tests, considering all surgical options. If a person is not eligible for surgery, alternatives such as Responsive Neurostimulation (RNS), Vagus Nerve Stimulation (VNS), or Deep Brain Stimulation (DBS) devices can be considered.

When choosing deep brain stimulation therapy, the following factors are taken into account:

• The type of symptoms the individual experiences.
• The best way to minimize surgical risks and maximize the benefits of deep brain stimulation.

Before the surgery:

• The patient provides their medical history, including allergies, medications, reactions to anesthesia, and previous surgeries.
• They should stop taking all non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Naproxen, as well as blood thinners (Coumadin, Aspirin, Plavix) seven days before the surgery.
• Avoiding alcohol and nicotine one week before the surgery and two weeks afterward to prevent bleeding and complications during the healing process.
• The patient is asked to wash their skin and hair using Hibiclens or a special soap before the surgery.
• No food or drink is allowed on the night before the surgery.

During the surgery:

The entire procedure takes about 5 to 7 hours, with the surgery itself lasting 3 to 4 hours. The first step involves temporarily placing a stereotactic targeting frame on the patient’s head using Velcro straps. The four pin sites are injected with local anesthesia, followed by mild sedation. The hair is shaved about an inch wide along the incision line. A skin incision is made across the top of the head, and two burr holes are created on the left and right sides of the skull using a drill. Through these holes, an electrode is inserted into a specific predetermined location within the brain.

Subsequently, several tests are conducted, such as raising the arms or legs, or counting numbers. Brain cell activity is displayed on a computer, precisely identifying the location of the nerve cells. A plastic cap is placed over the hole to secure the electrode in place, and a lead wire is left beneath the scalp to be later connected to the extension wire and the stimulator. Finally, the scalp incision is closed with sutures, and a dressing is applied.

After the surgery:

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

Stimulator implantation surgery:

A portion of the scalp incision is reopened to access the electrical leads. A small incision is made near the collarbone, and the neurostimulator device is implanted under the skin. It is then connected to an extension wire that is passed beneath the scalp, down the neck, and to the stimulator in the chest.

Stimulator programming:

The stimulator is programmed approximately 10 days after the surgery to adjust the medication dosage accordingly. Re-programming sessions are conducted every 3 to 4 weeks to achieve maximum control of symptoms while minimizing side effects. Most people do not feel the stimulation because it reduces their symptoms, although some individuals may experience a brief tingling sensation when the stimulator is turned on for the first time.

Risks

Treatment carries potential risks and side effects, but they are minor and reversible. Deep brain stimulation is safe and effective in properly selected patients.

The risks include:

• The risks include a 1% risk of bleeding in the brain, including stroke.
• Infection.
• Device malfunction.
• Lack of benefit for specific symptoms.
• Headache.
• Deterioration of mental or emotional state.

Side effects during stimulation may include:

• Temporary tingling in the face or limbs.
• Muscle tightness.
• Speech or vision problems.
• Loss of balance.

Other uses of deep brain stimulation:

Deep brain stimulation is also used to treat Parkinson’s disease, dystonia, and obsessive-compulsive disorder symptoms. It is considered a surgical treatment when medications are ineffective for these conditions. Deep brain stimulation has been used to treat over 160,000 individuals with various neurological conditions.

Deep brain stimulation and multiple sclerosis in Türkiye

The medical staff of surgical teams, doctors, and consultants at REHABTÜRK can provide the best treatment options and free consultations, striving to keep abreast of the latest medical technologies and methods.

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