What is Neuromodulation?
Neuromodulation is among the most rapidly growing and promising areas in medicine and involves the use of advanced neurological pacemakers and microinfusion delivery devices to deliver calming electrical signals, medications and other therapeutic agents precisely into the brain, spinal cord and the nervous system. In the United States, a growing number of neuromodulation procedures are receiving FDA approval and are covered by insurance. These include:
- Deep brain stimulation (DBS)/brain pacemakers for Parkinson's disease, tremor, dystonia and obsessive compulsive disorder
- Spinal cord and nerve pacemaker implants for chronic pain, epilepsy and urinary incontinence
- Microinfusion device implants for spasticity and chronic pain
What is DBS?
DBS is a cutting-edge surgical procedure that can improve the quality of life and physical disability for persons suffering from neurological disorders. DBS involves neurosurgical implantation of tiny electrodes into the brain that are connected to a small battery-like pacemaker device implanted into the chest wall. The electrodes deliver tiny electrical signals that calm abnormal brain signals. The result is to alleviate long-troublesome disabling symptoms and restore patients to better functioning.
Is DBS for Me?
Individuals interested in DBS undergo a detailed screening and evaluation by our multidisciplinary team to determine the likelihood of a successful response.
Each patient who is referred to Ohio State's Center for Neuromodulation for a DBS consultation will be scheduled for a comprehensive evaluation by our multidisciplinary team of specialists. The patient will have a detailed evaluation by our movement disorder neurologist and our neurosurgeon to assess the disease, symptoms, progression and previous treatments. The patient will have brain imaging performed and will also be evaluated by a neuropsychologist. The neuropsychological testing helps in understanding a patient’s cognitive (thinking, memory, concentration, attention) status and also provides a baseline for the team to monitor the patient over time. Finally, the team will have a detailed discussion with the patient and family about goals and expectations from surgery, plus review the benefits and side effects.
Once these evaluations are completed, the team will discuss each patient at a patient management conference. During this conference, a final recommendation by the entire group is made regarding surgery and other therapies, such as further medication adjustments and an individualized rehabilitation program.
Our team-oriented approach applies to all aspects and phases of patient care, through the initial evaluation, surgery, post-operative care and rehabilitation. Our goal is to work closely with the patient, family, caretakers and the referring physicians to develop a comprehensive and holistic care plan.
DBS for essential tremor is for patients with persistent and severe arm tremor with limited or no significant benefit from medications, and/or who are experiencing side effects from medications.
DBS for Parkinson’s disease is for patients with:
- Debilitating hand and/or leg tremor that fails to respond to medications.
- Idiopathic Parkinson's disease with disabling rigidity, slowness of movements, freezing, "on-off" fluctuations, intolerance to medication trials and/or reduced responsiveness to medications.
- Problematic uncontrollable motor fluctuations including excessive involuntary movements (dyskinesia) and/or frequent end-of-dose wearing off.
DBS for dystonia is considered when a person has significant debilitating symptoms of primary dystonia and has failed to respond to oral medication, botulinum toxin therapy, and other treatment modalities.
It is also important that a person considering DBS have realistic expectations as to what symptoms may or may not improve. Additionally, family and support structure needs to be in place to help the patient with follow-up care and appointments. The decision as to whether or not to pursue DBS is difficult, and it is helpful to seek guidance from a team of experts in neurosurgery and neurology who have experience with DBS therapy.
What Are the Risks Associated With This Procedure?
No surgery is without risks. The DBS risks include possible bleeding, stroke, infection, device-related problems, and the general risk of anesthesia. In our program, we are very thorough in providing patients and their families with detailed information about potential risks and benefits so that they can make a clear and informed decision about surgery.
If you would like to learn whether you are a candidate for DBS, please contact your current healthcare provider for an initial evaluation. Your physician and other care providers can help determine whether you may benefit from a referral to our Center for Neuromodulation.
Ohio State is ranked among “America’s Best Hospitals” for neurology and neurosurgery by U.S.News & World Report. The success of our DBS program is due, in part, to the strong multidisciplinary teamwork and collaboration among our neurosurgeons, movement disorder neurologists, psychiatrists and psychologists, physical medicine and rehabilitation specialists, as well as our nurses, physician assistants and patient coordinators. This teamwork and our comprehensive evaluations ensure optimal selection of surgical candidates and enables us to make the best choices for patient outcomes.
Dr. Ali Rezai, a world-renowned neurosurgeon and neuromodulation specialist, is the director of the Center for Neuromodulation. Dr. Rezai is an internationally recognized DBS surgeon who has performed more than 1,600 DBS surgeries and thousands more neuromodulation procedures.
If you need further assistance or would like to learn more about deep brain stimulation (DBS), please contact the Center for Neuromodulation patient coordinator at 614-366-6639.