Asleep Deep Brain Stimulation Now Available at UHealth

Deep brain stimulation (DBS) can relieve symptoms of stiffness, slowness and tremors in people who have Parkinson’s disease and another movement disorder called dystonia. However, many people decide against this treatment option, and it’s easy to understand why. Getting started requires brain surgery—and patients have to be awake for almost the whole procedure.

But now there’s good news: The Movement Disorders Center at UHealth—the University of Miami Health System is offering an alternative called “asleep DBS.” This option allows patients to have the same surgery while under general anesthesia. Thanks to the center’s cutting-edge technologies, it can be just as effective as the “awake” option.

Dr. Jonathan Jagid, right, in surgery.

“In the past, more than half of the patients I talked to about DBS declined to have surgery because they didn’t like the idea of being awake for the surgery,” said Jonathan R. Jagid, M.D., a UHealth neurosurgeon and director of functional and epilepsy neurosurgery. “Now that we are offering asleep DBS, I expect many more people in our community will have this therapy, which can improve their quality of life significantly.”

Who can benefit from DBS?

Ideal candidates for DBS are people with Parkinson’s disease or dystonia who are no longer getting good results from medication to control their movement-related symptoms, according to Corneliu Luca, M.D., Ph.D., a UHealth neurologist and director of the DBS Program. “Maybe medication worked well for them previously, but it isn’t any more, or they are having to take more medication to receive a benefit.”

Dr. Luca says patients who are interested in learning more should make an appointment for a comprehensive evaluation at the Movement Disorders Center. During this evaluation, patients will meet with a neurologist, neurosurgeon and neuropsychologist to talk about their symptoms and undergo testing. If the team recommends DBS, patients can decide between the “awake” and “asleep” options.  What is deep brain stimulation?

Stiffness, slowness and tremors are the most obvious symptoms of Parkinson’s disease and dystonia. Experts believe that DBS helps reduce these symptoms by interrupting abnormal electrical signaling patterns in the brain. The therapy does not treat symptoms such as poor balance, cognitive impairment and trouble speaking.

In DBS surgery, the neurosurgeon places thin wires called electrodes through the skull into one or both sides of the brain. Using detailed magnetic resonance and computed tomography images, the neurosurgeon pinpoints the exact targets deep in the brain and positions the electrodes.

Within a week or two, the patient returns to the hospital for a second surgery to place a small neurostimulator under the skin near the collarbone. The electrodes are connected to the neurostimulator, which delivers continuous electrical pulses.

Patients return to the neurologist every few months to make sure the therapy is working well. The patient and doctor can adjust the electrical stimulation levels using a remote-control device.

Specialized technology improves accuracy

During the surgery to place the electrodes, the neurosurgeon is aiming for a target in the brain that is 4 to 5 millimeters wide. Missing it, even by a millimeter, can affect surgical results and lead to unwanted side effects. In order to confirm that the electrode is in place during “awake DBS,” the surgeon asks the patient to perform tasks and answer questions. They can’t do this during asleep DBS, but there is a work-around.

“If needed, we can control the direction of the electrical current after surgery in the clinic setting by using the remote-control device,” Dr. Jagid said. “This new engineering innovation greatly improves, and increases consistency of, the therapy. Additionally, we are going to introduce new planning software that creates three-dimensional views of the brain, including the target area. This software will help us do an even better job of navigating to the precise target area.”

Experience makes a difference

More than 1,000 DBS implants have been performed at the University of Miami since the Movement Disorders Center began providing the therapy in 2005. Neurosurgeons offer it mainly to people with movement disorders, but it’s also available for people with epilepsy and some psychiatric conditions.

Dr. Jagid stresses the importance of an experienced team and multidisciplinary approach for people who are considering DBS. “We do as many as 70 DBS surgeries for movement disorders every year, and that is a high patient volume compared to other programs in South Florida,” Dr. Jagid said. “The neurosurgery team works closely with neuropsychologists, neurologists who are fellowship-trained in movement disorders, and many other specialists to make sure patients get the most benefit from this therapy. That begins with a thorough evaluation that includes imaging studies and other tests.”

Most patients are referred to the Movement Disorders Center at the University of Miami by a neurologist or primary care physician. To learn more about deep brain stimulation at UM, visit the web page or call (305) 243-2781.

Tags: deep brain stimulation, Dr. Corneliu Luca, Dr. Jonathan Jagid, UHealth Movement Disorders Center