If you are suffering from epilepsy, you are not alone. There are 50 million people suffering from epilepsy worldwide and 10 million of them are in India. However, the majority of these patients can be managed with medical treatment and over a period of time become seizures free. A small percentage of patients, approximately 30%, of the patients do not respond to one, two, or three lines of medications. These patients may be surgical candidates. Surgery can help control or cure epilepsy depending on the type of epilepsy. If it is temporal lobe epilepsy or epilepsy resulting from some lesion then surgical excision or removal of the temporal lobe can almost offer a cure to this patient. However after this also, there is a large number of patients who do not respond to either medical or conventional surgical management. It is this group of patients who have to find alternative forms of treatment example vagal nerve stimulation or deep Bridge stimulation. If your epilepsy is not getting any better with the treatment you are presently receiving, you may want to opt for deep brain stimulation or DBS. As a part of this treatment, your surgeon will place small electrodes in some areas of the brain to help in controlling your seizures.
How Does DBS Work?
The human brain has billions of nerve cells known as neurons. Electrical impulses successfully carry messages from one neuron to the other. If you have epilepsy, abnormal bursts of electrical activity in these neurons cause seizures.
During the process of DBS, the tiny electrodes that your surgeon places into your brain successfully deliver an electric current. This results in the interruption of abnormal electrical signals, thereby helping in the prevention of seizures. It is like having a pacemaker for the brain. Another explanation for this is that the chronic stimulation of the thalamus, where these electrodes are implanted, increases the threshold for seizure propagation, thereby reducing the chances of those electrical disturbances propagating to distal parts of the brain.
Who Can Benefit From DBS?
Most individuals try medications initially to control seizures, but anti-seizure medications do not work in around 30% of those with epilepsy. That said not every individual with epilepsy should undergo this procedure.
DBS is surely an option if other treatments for epilepsy do not work, or your doctor does not recommend them. The surgical procedure will not destroy your brain tissue or cause several of the language and memory problems that could be a side effect of other different types of surgery.
Most commonly if your seizures are disabling and/or frequent, that is more than a few times, in a month, not responding to conventional one, two, or three lines of medications, one can consider the option for DBS.
How To Prepare?
Your doctor will need you to undergo certain tests to ensure that DBS is the apt treatment for you. You may also have to show your doctor your MRI (magnetic resonance imaging) and CT (computed tomography) scans to show images that let your surgeon find the most precise region of your brain to place the electrodes.
What To Expect?
Usually, DBS is done while you are still awake. You will be administered medications for relaxation and prevention of pain. Your doctor will then attach a metal frame to your head to ensure that it stays still during the procedure. They will shave your hair in that region of your head where the procedure will be carried out.
Your surgeon will then place one or two very fine metal wires known as leads into that region of your brain where your seizures begin. The electrodes are eventually attached to another wire that travels down your neck. This wire is connected to a small device known as a pulse generator or neurostimulator, which is placed beneath the skin just below the collarbone or beneath the skin of your belly. Electrical signals will then travel from the neurostimulator to the leads placed in your brain.
Post-surgery, your doctor will turn on the DBS device with a small computer known as a programming unit. They will use it to adjust the speed as well as the intensity of the electrical signals so that your seizures are within control. You will also get a programming unit to take along with you to your home so that you can adjust your device and successfully track any seizures that you experience.
DBS may not stop your seizures in totality, but it will be able to cut them down in number. In one study, individuals who underwent DBS had 56% fewer seizures by their second year with their device.
After you receive your DBS device, you will need to return to your doctor regularly for follow-up visits. Moreover, you will need to get a replacement battery every three to four years.
Risks
DBS is usually safe, but the device and the surgery can lead to side effects.
Risks that arise from DBS surgery are mentioned below:
- Bleeding in the brain
- Stroke
- Breathing difficulty
- Infections
- Heart complications
- Seizures
- Headaches
Side effects that arise while making use of the device include:
- A tingling sensation or numbness
- Speech issues
- Difficulty in balancing
- Tight facial or arm muscles
- Dizziness
- Depression and mood fluctuations
These complications can be significantly reduced by an experienced team. One should not select any center that has less than 300 DBS surgery experiences.
Deep brain stimulation is merely one possible treatment for epilepsy that is hard to control. Speak to your doctor and consider all options. You must have complete knowledge and surety of how DBS will help control your epilepsy and the risks associated with the procedure.
To Sum It Up
DBS (deep brain stimulation) is a surgical procedure carried out to prevent the occurrence of seizures in those with epilepsy. According to the findings of one study, individuals who opted for DBS had 56% fewer seizures by their second year. During the procedure, electrodes are implanted within the brain and controlled by a pacemaker-like device known as a pulse generator or neurostimulator. Speak to your doctor if this is the right treatment to manage your condition.
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