Deep Brain Stimulation

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RNS implantation

There are several techniques available for controlling seizures that do not offer the possibility of cure but can dramatically reduce seizure frequency and severity with minimal risks. Vagal nerve stimulation (VNS), responsive neurostimulation (RNS, shown above), and deep brain stimulation (DBS) are less invasive surgical options for controlling epilepsy. They all use an implanted device, similar to a pacemaker, to send signals to the brain to prevent seizures. (More about advanced surgical options for epilepsy.)

Deep brain stimulation (DBS) is a minimally invasive surgical procedure that uses a neurostimulation device — similar to a heart pacemaker — to deliver electrical pulses to a very precise location in the brain. The abnormal activity in these circuits may causes symptoms including tremors and seizures; the electrical pulses from the DBS device blocks the activity of these circuits to reduce or eliminate the symptoms.

The procedure involves placing a battery-operated neurotransmitter under the collarbone. The device is connected to a wire implanted under the skin that runs up the length of the neck into the scalp, where it is guided to the brain through a small hole in the skull. The tip of this wire sends the electrical impulses generated by the neurotransmitter into the precise spot in the brain that regulates the activity of the key circuits in essential tremor.

The procedure is usually done in two stages. The first stage, in which the electrode is placed in the brain, is done while the patient is awake in order to provide feedback during surgery and to permit monitoring of brain activity to make sure that the electrode is placed in the correct location. Other than a brief pinch for injection of local anesthetic to numb the skin, there is generally no pain associated with this procedure. The second stage, in which the neurotransmitters are placed under the collarbone and connected to the end of the electrode left just under the skin, is very similar to that of receiving a heart pacemaker. This second procedure is performed with the patient asleep under general anesthesia, since it does not require any feedback.  

As with all surgical procedures, DBS poses a small risk of bleeding and infection. There are also potential risks related to the device, such as breakage or movement of a wire. The major benefit of DBS, however, is that it does minimal damage to the surrounding brain tissue, as can happen with other surgeries. The implanted device can also be reprogrammed wirelessly and painlessly without additional surgery, so that the treatment is individualized to each patient, and the therapy can be reversed as technologies advance for improved treatments in the future.

 More about our Epilepsy Program and Pediatric Epilepsy Program