OVER 1400 DBS LEADS IMPLANTED ANNUALLY
SpecialtyCare’s Deep Brain Stimulation (DBS) Service
SpecialtyCare is an industry leader in deep brain stimulation, an established therapy used to treat movement disorders. Our DBS team guides the placement of more than 1,400 DBS leads every year, providing expertise to our partners in microelectrode recording and stimulation mapping techniques. Our neurophysiologists receive the most comprehensive training in the industry and gain hands-on experience at some of the most respected DBS centers in the country.
What is Deep Brain Stimulation or DBS?
Deep brain stimulation is a therapy that uses permanently implanted electrodes to deliver focused electrical impulses to brain areas with abnormal activity. DBS is most commonly used to treat movement disorders such as Parkinson’s disease, Essential Tremor, and Dystonia, but has also been approved for the treatment of obsessive-compulsive disorder and epilepsy in certain patients. DBS is typically used for patients whose symptoms have not responded well to medications or for those whose medications no longer adequately control their symptoms.
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What Happens During DBS Surgery
On the day of surgery, the patient is fitted with a specialized frame used to place a DBS lead with high precision into brain areas identified in MRI scans. Local anesthesia is used to numb the scalp, a small hole is made in the skull, and thin recording wires called microelectrodes are passed into the brain to map the intended brain target in high resolution. This step is commonly referred to as microelectrode recording (MER).
After the target is localized with MER, test stimulation is typically applied by a small contact on the microelectrode to further refine the placement of the lead. This step ensures that the patient’s symptoms are treated well at low stimulation thresholds (which can prolong battery life) and that unintended side effects do not occur. Once the desired impact is obtained, the test electrode is replaced with a permanent DBS lead. In most centers, patients are kept awake during mapping and implantation so that the effects of stimulation can be determined with a high degree of accuracy.
The DBS lead is then connected to a specialized battery called an internal pulse generator (IPG), placed below the collarbone while the patient is asleep. The IPG is typically implanted in a separate procedure a week or two after placement of the lead. The IPG is subsequently programmed by the patient’s neurologist to deliver the appropriate amount of stimulation to treat their symptoms.
DBS therapy is well known to improve the quality of life for most movement disorder patients that are referred for DBS surgery. It can be a welcomed relief to patients whose quality of life has been dramatically affected by their disease or by medication side effects.
Deep Brain Stimulation (DBS) Research
All of our DBS staff have strong research backgrounds in neuroscience, and many of them hold academic positions at prestigious institutions such as Vanderbilt University, Northwestern Medicine, and Pennsylvania State University. These appointments have allowed our staff to apply their academic training to help advance the clinical practice of DBS, as evidenced in the following publications:
Bhusal B, Stockmann J, Guerin B, Mareyam A, Kirsch J, Wald LL, Nolt MJ, Rosenow J, Lopez-Rosado R, Elahi B, Golestanirad L. Safety and image quality at 7T MRI for deep brain stimulation systems: Ex vivo study with lead-only and full-systems. PLoS One. 2021 Sep 7;16(9):e0257077..
Nolt MJ, Polasani RS, Masnyk TW, Rezak M, Rosenow JM. Prospective Evaluation of the Time Course of White Matter Edema Associated with Implanted Deep Brain Stimulation Electrodes. Stereotact Funct Neurosurg. 2021;99(3):203-206.
Jones MR, Baskaran AB, Nolt MJ, Rosenow JM. Intraoperative Computed Tomography for Registration of Stereotactic Frame in Frame-Based Deep Brain Stimulation. Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):E186-E189.
Huntoon KM, Young NA, Look AC, Deogaonkar M. Direct Comparison of Posterior Subthalamic Area Stimulation versus Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease. Neurol India. 2020 Jan-Feb;68(1):165-167
Young NA, Brown MP, Peng J, Kline D, Reider C, Deogaonkar M. Predicting extended hospital stay after deep brain stimulation surgery in Parkinson’s patients. J Clin Neurosci. 2019 Nov;69:241-244.
Brandmeir NJ, Brandmeir CL, Carr D, Kuzma K, McInerney J. Deep Brain Stimulation for Parkinson Disease Does not Worsen or Improve Postural Instability: A Prospective Cohort Trial. Neurosurgery. 2018 Dec 1;83(6):1173-1182.
Felix RA, Gourévitch B, Portfors CV. Subcortical pathways: Towards a better understanding of auditory disorders. Hear Res. 2018 May;362:48-60.
Park YS, Sammartino F, Young NA, Corrigan J, Krishna V, Rezai AR.Anatomic Review of the Ventral Capsule/Ventral Striatum and the Nucleus Accumbens to Guide Target Selection for Deep Brain Stimulation for Obsessive-Compulsive Disorder. World Neurosurgery. 2019 126: 1-10.
Camalier CR, Konrad PE, Gill CE, Kao C, Remple M, Nasr HM, Davis TL, Hedera P, Phibbs FT, Molinari AL, Neimat JS, Charles D. Methods for Surgical Targeting of the STN in Early-Stage Parkinson’s Disease. Front Neurol. 2014 Mar 19;5:25
Charles D, Konrad PE, Neimat JS, Molinari AL, Tramontana MG, Finder SG, Gill CE, Bliton MJ, Kao C, Phibbs FT, Hedera P, Salomon RM, Cannard KR, Wang L, Song Y, Davis TL. Subthalamic nucleus deep brain stimulation in early stage Parkinson’s disease. Parkinsonism Relat Disord. 2014 Jul;20(7):731-7.
Kahn E, D’Haese PF, Dawant B, Allen L, Kao C, Charles PD, Konrad P. Deep brain stimulation in early stage Parkinson’s disease: operative experience from a prospective randomised clinical trial. J Neurol Neurosurg Psychiatry. 2012 Feb;83(2):164-70.
Remple MS, Bradenham CH, Kao CC, Charles PD, Neimat JS, Konrad PE. Subthalamic nucleus neuronal firing rate increases with Parkinson’s disease progression. Mov Disord. 2011 Aug 1;26(9):1657-62.
Konrad PE, Neimat JS, Yu H, Kao CC, Remple MS, D’Haese PF, Dawant BM. Customized, miniature rapid-prototype stereotactic frames for use in deep brain stimulator surgery: initial clinical methodology and experience from 263 patients from 2002 to 2008. Stereotact Funct Neurosurg. 2011;89(1):34-41.
Gilmour TP, Lieu CA, Nolt MJ, Piallat B, Deogaonkar M, Subramanian T. The effects of chronic levodopa treatments on the neuronal firing properties of the subthalamic nucleus and substantia nigra reticulata in hemiparkinsonian rhesus monkeys. Exp Neurol. 2011 Mar;228(1):53-8.
Remple MS, Sarpong Y, Neimat JS. Frontiers in the surgical treatment of Parkinson’s disease. Expert Rev Neurother. 2008 Jun;8(6):897-906.
Services Provided by Our DBS Team
Each member of our highly trained DBS team brings a wealth of experience to every DBS lead implant case, providing unmatched support throughout every aspect of the procedure. Our staff provides a highly-customized, data-driven, and efficient mapping protocol that improves treatment efficacy without adding significant time to the surgical procedure. Contact us to learn how we can provide any combination of the following services to your hospital:
- Provide specialized capital equipment necessary for subcortical brain mapping, including microelectrode recording and microdrive systems
- Assistance with surgical planning
- Set up, operation, and troubleshooting of neurophysiology systems
- Consultation on technical issues related to the DBS procedure
- Didactic support for OR staff, residents, and visitors regarding the theory and practice of DBS
- Operation of microdrives that advance microelectrodes, eliminating the need for the surgeon to scrub out during the lead implant procedure
- Identification and classification of neurons responsive to kinesthetic, tactile, or visual stimulation during MER
- Assistance in the identification of stimulation-induced treatment efficacy and side effects
- Summarize technical interpretation of MER and test stimulation results to the surgeon to assist in determining the optimal location for the implanted DBS lead
- Provide scientific support for ongoing research projects
DBS Treatment Through SpecialtyCare
Hospitals and surgeons all over the United States rely on our highly experienced, PhD-trained DBS specialists. Our team guides the placement of one in every six DBS leads in the nation. Our extensive experience and specialized training in DBS mapping protocols and equipment ensures that your surgeon receives the best guidance available without adding significant surgical time to the procedure.
Let SpecialtyCare’s Deep Brain Stimulation (DBS) Team Help
Our approach to deep brain stimulation (DBS) is based on the belief that a combination of clinical excellence, compliance, and dedicated personal service is needed to ensure the very best in patient care and cost management. At SpecialtyCare, our goal is to help you build a surgical team and operating room of excellence and to provide the best outcomes. Patient care and support will always be our first and last priority.