Deep Brain Stimulation (DBS)

Deborah
This is “Weekly Dose of Wellness”, brought to you by MemorialCare Health System. Here's Deborah Howell.

Melanie
This is Melanie Cole sitting in for Deborah Howell. And you're listening to A “Weekly Dose of Wellness” brought to you by MemorialCare Health System. My guest today is Doctor Devin Binder. He's a neurosurgeon at Orange Coast Memorial Medical Center. Welcome to the show, Doctor Binder.

Dr. Binder
Thank you. It's great to be with you.

Melanie
So tell us a little bit about deep brain stimulation. What is it exactly?

Dr. Binder
The deep brain stimulation is a treatment that involves the insertion of what is called a brain pacemaker. Essentially, a an electrode is inserted into the brain into a deep part of the brain. Hence deep brain stimulation. And it's, navigated to a target with extreme accuracy. And that is able to stimulate that target. It's connected to through a wire underneath the skin to a battery in the upper chest. And it essentially serves just like the cardiac pacemaker will change the aim of the heart. The deep brain stimulation device changes the rhythm of the brain, and it's, it's used in a very careful way by neurosurgeons and neurologists to treat a number of disorders.

Melanie
What would those disorders be Doctor Binder?

Dr. Binder
Primarily movement disorders. So there's that, group of structures deep in the brain in a structures called the basal ganglia, which we target for, for the deep brain stimulator, electrode placement. And the treatment, involves essential tremor, Parkinson's disease and dystonia. These are three distinct movement disorders that have all been shown to benefit from deep brain stimulation.

Melanie
So with deep brain stimulation, what's involved in this procedure exactly?

Dr. Binder
So patients undergoing deep brain stimulation get a very high resolution MRI scan of the brain, much more than a typical MRI. In order to delineate the structures very carefully. It deep in the brain that we're going to be targeting, it's very important that we get within one millimeter of the targets or right on the target, because even seven millimeter, several millimeters off in the brain is like a mile away in terms of function, as the brain is so, so carefully subdivided into different areas. So we identify the structures on the MRI before surgery. And then on the morning of surgery, the patient is sedated and, we get a, they're placed in a head frame. And we do this all with the patient's, comfort at the utmost. They sit in a beach chair like posture, and we very sterilely open a small opening. And, the electrodes and wires, very thin wires that are, sent down towards the target. And we listen to the brain activity, something called electrophysiology or neurophysiology. We listen to the brain activity of different structures so that we can be absolutely sure that we're in the correct place.

Melanie
Now, who might quote, well, so who might qualify for this Doctor Binder and who might not qualify for this?

Dr. Binder
Excellent question. So people with these conditions, as I mentioned, essential tremor, dystonia, Parkinson's disease have severe movement disorders. And the, when the disorder is mild, it generally can be treated with medication so that that, patient with mild disease would not be considered a good candidate. However, once the disease gets to a point where medications lose effectiveness or the medications themselves, which can cause severe side effects, then we have to think about deep brain stimulation because DBS is, able to control the symptoms of the disorder without the same side effects as medication.

Melanie
And now if they are in the process of trying to qualify for this, what might disqualify them for this?

Dr. Binder
General medical health is very important. Obviously, when you're going through any surgical procedure where electrodes are implanted, just like you would with any procedure, the health of the heart and the lungs is very important. Secondly, the person's cognitive status, meaning how with it are they? Do they have any memory loss? Do they have any other neurological problems? Generally, we try to do this in people who are very able to participate in this form of therapy, because it requires a lot of active participation on the part of the patient. So overall, though, there's a, great number of people that are excellent candidates who are at that stage of the disease where they haven't had severe degeneration of the brain, but they're able to, really benefit from DBS controlling the symptoms.

Melanie
And what how long until after they have the procedure? Will they start to see benefits and what are the benefits? You know, these are movement disorders that we're speaking of. So Parkinson's and the tremors, dystonia, as you've been speaking of, what is the benefit? Is it going to reduce the amount of tremors, the severity of the tremors? What's the benefit to the patient?

Dr. Binder
That's exactly right. It reduces the in the case of tremor. That's a great example. We are able to control tremor extremely well with DBS. So that particular problem that is true. And patients with Parkinson's and also patients with this condition for the essential tremor we're able to control tremor extremely well with DBS much better than with medication. So one of the most exciting things in my professional life is when I have a patient, in during the procedure, we actually wake people up temporarily for about 15 minutes to, to test the effect of stimulating the electrode in the position that it's in, in the operating room. And in looking at the effect on the tremor. And what's remarkable is once you hit the right spot again in the right millimeter of tissue, you can find that tremor area. Get rid of the tremor immediately in the operating room. At that point, you know that that person is going to have a great outcome in terms of control of the tremor. Most often. Then we see, benefits really immediately. But then over time, together with medication adjustments, in the neurologists office and deep brain stimulation programing of the of the battery and voltage, we're able to actually get an excellent control over not only the tremor, but other things like stiffness and slowness of movements.

Melanie
And what about some other diseases that this might possibly help? Are we looking forward towards maybe even MS or something like Tourette’s or, you know, any of these other sort of tremor-like diseases, things that might even headaches is there on the horizon, some things that could either be used for.

Dr. Binder
That's really a fantastic question. I really think that there's so much on the horizon. First of all, you mentioned Tourette's syndrome, Tourette's syndrome is a condition where people have, tics. T I C S which are abnormal, involuntary, often vocal tics, like utterances. These things can also be controlled by deep brain stimulation. There are a number of studies for DBS, for Tourette's. You mentioned headache. There's a type of headache called cluster headache, in which studies have shown that actually deep brain stimulation of a different part of the brain can actually control the headache. Most exciting. I think, is, studies of depression and studies of obesity that are coming out, basically indicating we can, impact, people with severe depression and obesity with DBS. And furthermore, it's DBS is already, approved by the FDA, for, obsessive compulsive disorder, which is really quite remarkable that that a target was found in the brain that would, would help with, the OCD patient's symptoms.

Melanie
I was actually going to ask you about obsessive compulsive disorder, because, again, that's another one of those things that, you know, can originate in the brain. Now, how long does it last? Is this a permanent implantation? Is it something that once it's there, it's there.

Dr. Binder
That's right. Once it's there, it's there. I've had the rare patient where if they got, for example, I had a patient with a whiplash injury several months after surgery, and they, you know, the electrode was was pulled from the battery and had to be replaced. That type of thing can happen, but generally, once it's in place under the skin, everything's healed up a few weeks after surgery. It's in place and it can be adjusted though externally in the neurologist’s office. in terms of the programing, but the studies are actually up to at least ten years. We have good effects on the symptoms. And that's approximately how long the studies have gone so far. but it appears to be durable, for quite some time.

Melanie
And has it changed over the years? This surgery?

Dr. Binder
Yes. the most important advances in surgery in general and DBS in particular, are, more precise, targeting to make sure we're at the right place that we and that we don't damage, very important that we don't damage any other areas of the brain. Fewer complications, reducing the bleeding rate and reducing the infection rate, and overall making the device, much more reliable. So over the past decade or so, that DBS has been really grown in the United States and worldwide, there's been a great attention paid to making this, quite a safe procedure.

Melanie
It's really amazing. And what about any side effects? Are there any?

Dr. Binder
Yes. So with, stimulating the brain, you have to be very, cognizant of the fact that you could stimulate unwanted areas. So if you stimulate at too high a voltage or too high an amplitude, you could end up stimulating areas that you that you don't want to. And patients could have side effects such as tingling or numbness in, arm or leg or certain other things like effects on the voice, like, vocal articulation problems. But that's something that we carefully adjust with the external program or in the, in the office to try to minimize the side effects and maximize the effects on the, on the tremor.

Melanie
Thank you so much, Doctor Binder. That's amazing information. And what an amazing surgery that you do. You're listening to “Weekly Dose of Wellness”. It's brought to you by MemorialCare Health System. If you want more information about DBS as a treatment option, go to MemorialCare.org. That's MemorialCare.org. You can get more information about this amazing procedure. This is Melanie Cole. Thanks for listening.