Posted by Brigham and Women's Hospital July 12, 2016
For some people with movement disorders like Parkinson’s disease and essential tremor, deep brain stimulation (DBS) can offer an effective treatment for symptoms that are not responding to medications. The traditional procedure to place the DBS electrodes, however, has required patients to remain awake during surgery. Patients who are candidates for DBS may now have this procedure performed under general anesthesia.
“This is a huge advance for patients opting for DBS,” said Dr. G. Rees Cosgrove, Director of Epilepsy and Functional Neurosurgery at Brigham and Women’s Hospital (BWH), the only hospital in New England and one of few nationwide to offer asleep DBS. “The imaging that we use while we perform the procedure enables us to confirm that we’ve reached the exact locations that we are trying to target in the brain while we are in the operating room, without the need to keep patients awake.”
At BWH, DBS electrode placement is performed in the Advanced Multimodality Image Guided Operating (AMIGO) Suite, which enables images, such as magnetic resonance imaging (MRI), to be obtained directly in the operating room. During surgery in AMIGO, MRI is used to guide placement of DBS electrodes and confirm the targets to reduce symptoms without adversely affecting language or other key areas.
In traditional DBS, surgeons rely on images taken before surgery and sounds generated by electrical activity in the brain to guide placement. With this approach, patients must remain awake during the four-to-six hour surgery to answer questions and perform tasks, such as moving arms and fingers when prompted, in order to confirm that the electrodes are positioned properly.
Dr. Cosgrove collaborates with a team of specialists in the Deep Brain Stimulation Program at BWH to evaluate and care for patients considering DBS. Patients are seen by specialists in neurosurgery, neurology, neuropsychology, and psychiatry during one visit. The team then meets to review the patient’s case and determine if DBS is appropriate. After the electrode and stimulator placement, programming of the device is performed in the office to levels optimal for the patient.
“Our goals are to develop the best plan for each patient and to improve quality of life by easing symptoms,” said Dr. Michael Hayes, Neurological Director for Functional Neurosurgery at BWH.
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