DBS Surgery?

can anyone fill me in on their personal success with the surgery and details such as their status prior to the surgery and recovery results? Where did you have the surgery? etc.

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  • 1 decade ago
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    DBS surgery is performed for several different reasons and the success rates depend a lot on what condition is being treated. As Pangolin said, when it's done for tremor it's usually very effective and you really can watch the person's tremor stop when the stimulator is turned on. If it's for Parkinson's disease, most people get some improvement, though the degree can vary quite a bit. The typical PD patient getting DBS is pretty debilitated and has reached a point where medications are not providing much relief, or that the effects don't last long enough between doses. In these people, DBS surgery helps cover that gap left by medications. Some people have dramatic improvement and can stop PD meds altogether, but most can only cut down on their medications or have better control of symptoms with their current medications. Furthermore, PD is a progressive disease, and the stimulator doesn't stop progression, so, at best, it hopefully provides a longer time with good quality of life, but it does not cure the disease.

    Other conditions treated include severe seizure disorders that don't respond to medical treatement. There are trials going on to use DBS as a treatment for severe Tourette's syndrome, and even severe, medically refractory depression. The success rates for these conditions are often lower, but the surgery is typically performed only in those people for whom no other therapy is working, so undergoing the surgery is considered worth the risk.

    Most academic hospitals with neurosurgery departments are capable of performing this type of surgery, which falls under the subspecialty of functional neurosurgery. Successful DBS surgery also requires a neurologist who's very familiar with the process. And, as with any surgery, the people who do them most often tend to have higher success rates. Most academic neurosurgery departments meet these criteria and I would avoid most private practice surgeons doing these procedures.

    Source(s): I'm a neurosurgery resident.
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  • 1 decade ago

    I haven't had this done personally, but have anesthetized people for the procedure, so I can tell you a little about it.

    The cases I have seen have been for tremors. The "before" situation is usually one where the patient is incapacitated by the tremor - cannot write, hold a cup of coffee,etc. We put the stimulator in, and test it right there in the OR.

    The results are immediate and dramatic. The tremor stops, or is barely noticeable.

    I don't know anything about the long term results, as I don't get to see these people after they leave the recovery room.

    Source(s): I'm an anesthesiologist. http://www.medicalminutepodcast.com
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  • 1 decade ago

    Deep stimulation brain surgery, is done under sedation and local anesthesia (usually through a frontal burr-hole with the tip of the electrode as deep as 9-10 centimeters, depending on the shape and size of the head of the individual patient), with a wire that has two poles, under the scalp. after some "flattening" of the bone, so that the stimulator (sometimes called wrongly pacemaker) is placed on a bone "niche" of about 1.5 inches in oblong space in the bone, with a special "diamond" drill, covering it with periosteum.

    The purpose for this procedure is manifold, (symptomatic relief of Parkinson, or Parkinson that does not respond to common drugs such as methyldopa, biperiden, benserazide, bromocriptine etc or the side effects are frankly intolerable, sich as it happens in aged persons), and other diseases such as intractable thalamic pain,

    It is done under magnetic resonance vigilance, and the procedure itself is generally painless, but uncomfortable, because the body of the patient has to be still, and the neck immobilized, in the MRI room, and at the same time, an aluminium frame is placed with "four points" in the forehead and neck of the head of the patient, with local anesthetic after the sedation with diazepam and phentanyl has been initiated, (the brain itself is not sensitive to pain, and can be introduced in the sedated semiconscious patient)

    The longest part of the procedure, is to locate the point where the tip of the double electrode is placed finally in the thalamus....

    The results, vary enormously, and I have personally been satisfied with good results in about 18 cases, and deeply dissapointed with 4....so there is a good margin for success, but failure can be corrected most of the time, with re-positioning of the stimulating electrodes to the thalamus.

    The age of the patient is important, because the DBS can be performed in patients with high cardiovascular risk (Goldman III and IV), when we adhere to the protocol.

    It is well worth to try it, when other techniques have failed.

    However, the cobalt based battery, has to be changed every 2and a half to three years, which means another procedure, and another risk, (of infection, failure and the lot),,,

    If the procedure is succesful, as it is generally, after repeating the CT scan (control CT scan) the day after, and checking clotting time, the patient is discharged to take the stitches off, 6-7 days later.......in the outpatient clinic...by our brave residents.

    Unfortunately, the procedure is NOT all satisfarory in the case of intractable seizures, in which, direct surgery of the brain, is preferable, with a higher rate of success,,,,Intractable depression, is treated by ventroposterior capsulotomy with radiofrequency, and we dont use DBS for it, (it does not work for that)

    I dont know how things are managed in America, but in Europe, the standard of neurosurgery and training of a neurosurgeon is quite demanding, and being an standard procedure, I dont see the difference between "private" and "institutional" neurosurgeon performing it, as far as results is concerned...

    Source(s): Professor of neurosurgery (Munich)
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