Deep brain stimulation is the impact on specific areas of the brain using electrical impulses. The source of the impulses is an implantable neurostimulator placed under the skin, and the impulses are transmitted to the brain through electrodes.
The implantation of a neurostimulator has proven to be an effective method for treating degenerative diseases of the extrapyramidal system, epilepsy, and a number of other pathologies. The neurosurgeons at our clinic are among the best specialists in this field, and the implantation of deep brain stimulation systems at the Top Ichilov center is performed using modern equipment – intraoperative MRI, stereotactic microsurgical instruments, and next-generation neurostimulators.
Deep Stimulation Technique
The deep brain stimulation method was first tested in 1987 for the treatment of Parkinson's disease. Today, this method is used worldwide to treat extrapyramidal disorders. More than 20,000 patients have undergone treatment using this method, many of whom had their neurostimulators implanted in Israel.
Modern neurostimulators can work for years without the need for replacement and are used not only for treating Parkinson's disease. They are used to treat tremors, dystonia, depression, chronic pain, Tourette syndrome, obsessive-compulsive disorder, and cluster headaches.
The deep brain stimulation system consists of two components – a pulse generator and an electrode implanted in the brain, which is connected to the generator via a thin insulated wire. The generator's casing is made of titanium and houses the generator itself, electrical batteries, and electronic circuits. The electrode is made of a platinum-iridium alloy. All components of the system are located within the patient's body, the generator is implanted under the skin in the chest area (under the collarbone), the electrode is implanted in the brain, and the connecting wire runs under the skin from the head through the neck to the collarbone. The generator can be programmed to change the parameters of the impulses sent to the brain, achieving optimal effects and reducing disease symptoms.
The location of the electrodes is chosen based on the area of the brain responsible for specific disorders. For example, when treating tremors, the electrode is implanted in one of the thalamic nuclei, for dystonia and Parkinson's disease – in the basal ganglia or subthalamic nucleus, and for treating depression – in the accumbens nucleus of the brain.
All components of the deep stimulation system are implanted surgically. The electrode implantation is performed microsurgically, creating an opening in the patient's skull. The operation can be performed under local or general anesthesia (as in the case of treating dystonia). If the implantation is performed under local anesthesia, the surgeon uses the patient's reactions to select the most precise location for the impact. Brain visualization and the electrode being introduced are performed using intraoperative MRI. The implantation of the generator and wires is done only under general anesthesia.
Before the implantation of a permanent electrode, brain mapping is performed – using a microelectrode, the surgeon studies the electrical activity of the brain and selects the optimal point for the placement of the permanent electrode. The patient remains conscious during this procedure, which takes between 30 minutes to 2 hours for each hemisphere of the brain. Once the desired point is found, a permanent electrode is inserted, which is then tested for the absence of side effects (such as tingling in the limbs, speech difficulties, etc.). The therapeutic effect after the start of deep brain stimulation occurs within several hours (in some cases – days).
If the electrode implantation is performed under general anesthesia, brain mapping is not conducted, and the appropriate point for electrode insertion is determined using magnetic resonance imaging.
Microsurgical deep brain stimulation in Israel receives positive feedback from patients and allows for the treatment of numerous diseases.
- Parkinson's Disease – using neurostimulation, Israeli doctors manage to minimize the symptoms of the disease and improve the quality of life for patients. The procedure is indicated for those patients who do not respond to traditional treatment or have intolerances to prescribed medications. In some cases, after the neurostimulator is implanted, patients continue to take special antiparkinsonian medications, but in reduced dosages.
- Chronic Pain Syndrome – neurostimulation of various areas of the brain helps alleviate pain, including neuropathic pain. According to the results of one study, the use of neurostimulators allowed 13 out of 17 cancer patients to completely eliminate pain and discontinue the use of narcotic analgesics. Deep brain stimulation can also be used to treat phantom pain.
- Depression and Obsessive-Compulsive Disorder – this area of neurostimulation is still developing but is already showing promising results, especially in patients with depression resistant to other therapeutic methods. Neurostimulation of various brain regions is used to treat depression, but recently doctors have found that electrical stimulation of the medial bundle of the frontal brain has an unexpectedly powerful effect, resulting in a rapid onset of antidepressant effects. Scientific research results on the use of neurostimulation for treating depression and obsessive-compulsive disorder show that approximately 50% of patients experience significant improvement.
- Tourette Syndrome – the use of deep brain stimulation for treating this syndrome remains experimental, although it shows good results. Neurostimulation can be used as a treatment measure for patients with complicated symptoms who do not respond to other types of therapy.
- Other Diseases – in some cases, deep stimulation can alleviate symptoms and improve the quality of life for patients with dystonia. Positive changes usually require time – from several weeks to several months. Neurostimulation is also used to treat therapy-resistant epilepsy and can at least reduce the frequency of epileptic seizures. Methods of deep brain stimulation are also being studied for alleviating symptoms of schizophrenia, narcolepsy, and some other central nervous system diseases. Today, in Israel, deep brain stimulation has successfully replaced less advanced methods such as surgical ablation of the thalamus or structures of the frontal brain.
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Microsurgical Deep Brain Stimulation in Israel – Prices
Microsurgical deep brain stimulation in Israel is considered an expensive operation, as the costs include not only the intensive work of neurosurgeons but also the price of the neurostimulator. Nevertheless, undergoing this procedure in Israeli clinics allows for savings of up to 50% compared to the costs required for neurostimulator implantation in medical centers in the USA and Europe.
Advantages of Deep Brain Stimulation at the Top Ichilov Center
- Operations for the implantation of deep brain stimulation systems at our clinic are performed by experienced neurosurgeons using high-precision modern equipment.
- Only the latest neurostimulators from leading global manufacturers are used for implantation – reliable and safe, with a long service life.
- The implantation procedure is performed using a minimally invasive microsurgical method, and the implanted electrodes do not harm healthy brain tissue.
- Neurostimulation can help patients whose diseases are resistant to other types of therapy. Even if the symptoms of the disease do not completely disappear after the neurostimulator is implanted, they are significantly reduced, and the patient's quality of life improves.
- Staying at our clinic is characterized by increased comfort. Patients reside in cozy rooms, surrounded by the attention of doctors and medical staff. Each patient has access to the services of a free curator-translator.
Patients who have undergone microsurgical deep brain stimulation in Israel leave warm and grateful reviews about the specialists at our clinic and thank them for the new quality of life they have been given within the walls of Top Ichilov.