• Deep Brain Stimulation (DBS)

  • Deep brain stimulation (DBS) is a surgical procedure used primarily to treat the motor symptoms of Parkinson’s disease, such as tremor, rigidity, masked face (loss of facial expression), slowed movement, and shuffling gait. The procedure may also be used for certain patients who have not responded to conventional treatments for dystonia, a movement disorder, and for chronic migraine.

    DBS surgery involves implanting an electrode in the patient’s brain, which is connected to a neurostimulator (battery pack), not unlike a pacemaker. The battery pack is implanted under the skin in the chest near the collarbone. Impulses from the neurostimulator interfere with and block the electrical signals that trigger motion disorders. Most patients see immediate benefits from DBS surgery. While DBS is not a cure for Parkinson’s disease, it can dramatically improve quality of life, allowing patients to maintain their independence, participate in everyday activities and return to work or continue working.

    Backed by Studies

    DBS has been FDA approved since 2002 and is backed by well-designed randomized controlled studies, the gold standard in medical research. The procedure has been shown to be a superior treatment to medications alone.  DBS has been used in more than 100,000 Parkinson’s patients since 1995, with 69% of patients showing a reduction in tremor. New findings suggest that DBS not only improves the symptoms of Parkinson’s disease but may also increase the patient’s lifespan. Experts now recommend that treatments be done at the first sign of motor fluctuations in Parkinson’s patients for best results.

    Two types of procedure:

    Typically DBS was given while the patient was awake, but recent advancements in technology allow the patient to be asleep, reducing the number of surgeries typically needed. Dr. David VanSickle, a leading expert on DBS at Littleton Adventist Hospital, is one of a handful of surgeons across the country, and the only surgeon in Colorado, to offer this breakthrough procedure.

    Using a new type of portable CT machine, called the CereTom, Dr. VanSickle is able to cut operating time in half compared to awake DBS. He obtains precise images of the brain during the surgery. Prior to this, the procedure required separate surgeries to place markers in the head, implant the generator, and connect the batteries. The new procedure eliminates the first surgery with the need for patient feedback throughout the surgery.

    A good candidate for DBS:

    • Has been diagnosed with moderate or severe idiopathic Parkinson's disease
    • Experiences a decline in the quality of life despite adequate medical therapy
    • Responds to a drug called Sinemet (carbidopa-levodopa); even a slight response qualifies
    • Experiences early to mid-range symptoms (if late stage muscle contractions and dementia have set in, DBS is not likely to improve quality of life)

    Deep Brain Stimulation for Obsessive-Compulsive Disorder

    In addition to its most common use in treating symptoms of Parkinson’s disease, deep brain stimulation (DBS) may offer hope for individuals with severe obsessive-compulsive disorder (OCD).

    In spring 2015, Dr. David VanSickle, a neurologist who has performed more than 600 DBS lead placements and a leading expert on robotic-assisted Asleep, performed the first two DBS procedures on patients with OCD in the state of Colorado. The surgeries were performed at Littleton Adventist Hospital, which has been approved by the Food & Drug Administration to perform DBS for OCD.

    When DBS is successful, a person with OCD can achieve a higher quality of life and may be able to participate in society in ways never before possible.

    Read Sara and Amanda Eldritch's story here.

    What to expect

    Deep brain stimulation for OCD is a relatively new treatment option for treatment-resistant OCD. Research on the procedure is based on small sample sizes, and DBS to treat OCD has not yet been approved for everyone with obsessive-compulsive disorder. The U.S. Food and Drug Administration has approved DBS to treat OCD under a Humanitarian Device Exemption for extreme cases.

    And while DBS has shown a great deal of promise for individuals with OCD, it is important to understand that DBS is not a cure for obsessive-compulsive disorder. In people with OCD, the goal of DBS surgery is to suppress the anxiety connected with OCD. This, in turn, increases the chances of therapy successfully addressing the habits associated with the disorder.

    Patients may see relief immediately after the DBS procedure or it may take several months to a year to achieve desired results. Patients typically will be seen several times following the surgery to properly program the DBS neurotransmitter.

    Optimal results following DBS surgery depend upon the patient’s participation in ongoing therapy. 

    Who’s eligible?

    To be eligible for the procedure, a patient must:

    • Be 18 years of age or older
    • Be in good general health
    • Have a severe or extreme OCD (YOBCS of 28 or higher) diagnosis
    • Have a documented duration of OCD of at least five years
    • Have OCD that fails to improve with medication, including at least three selective serotonin reuptake inhibitors, clomipramine and at least two antipsychotics
    • Have tried intensive cognitive behavioral therapy and Exposure and Response Prevention for 12 weeks or more

    A patient is not eligible for DBS for OCD if he/she:

    • Has hoarding as the primary subclassification
    • Has other neurological disorders
    • Has a cognitive disorder or dementia and cannot give informed consent
    • Has a serious psychiatric disorder in addition to OCD (for example, personality disorder or bipolar disorder)
    • Has substance abuse issues
    • Has had previous surgery that damaged the area of the brain being targeted by DBS
    • Is pregnant
    • Has an abnormal MRI
    • Is at imminent risk for suicide

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