Deep brain stimulation is a treatment that aims to reduce seizure frequency and severity in people with epilepsy when other treatments are ineffective.
Deep brain stimulation (DBS) is a type of neuromodulation treatment that affects how brain cells work. An implanted device delivers electrical currents to brain areas relating to seizures. DBS may help control seizures in some cases of epilepsy.
This article looks at who DBS may be suitable for, what the procedure involves, and how effective it may be for controlling seizures.
The purpose of DBS is to control seizures. The technique is not a cure for epilepsy, but it may help reduce the frequency and severity of seizures.
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In most cases, anti-epileptic drugs (AEDs) will effectively control seizures. However, in at least 30% of adults with epilepsy, AEDs are ineffective in controlling seizures. If surgery to operate on the seizure-causing area of the brain is not a viable option, a person may be a suitable candidate for DBS.
People must try at least two different types of antiseizure medications before doctors can consider surgery or DBS.
DBS surgery may involve the following:
- A person will first have a general or local anesthetic.
- The surgeon will place a frame on the head to ensure the correct placement of electrodes.
- They will then drill small holes into the skull to insert the electrodes.
- The surgeon will also place a small device called a neurostimulator underneath the skin, below the collarbone.
- A wire under the skin travels from the neurostimulator to the electrodes.
Around a month after surgery, a doctor will turn the device on with a programming unit. They can use this to adjust the stimulation level and monitor electrical activity. A doctor will provide the person with a handheld remote or magnet they can use to control the DBS.
To prepare for the DBS procedure, a doctor will perform examinations to assess their suitability for the technique.
Epilepsy specialists will be able to determine whether DBS may help people. They will consider:
- the type of seizures a person has
- how to minimize any risks of surgery
- how to achieve the most benefits
Doctors will also consider other options, such as responsive neurostimulation or vagus nerve stimulation.
Testing for DBS suitability may include:
- EEG testing
- imaging tests, such as an MRI scan
- cognitive neuropsychology testing, which assesses a person’s thinking ability
People can also use this evaluation period to ask their healthcare team any questions about DBS and to discuss any concerns they may have.
People will need to follow advice from their surgical team on recovery and returning to their everyday activities.
According to hospital advice, individuals need to keep their incisions dry until the removal of their stitches. They can still bathe or shower if they can keep them dry.
People may be able to remove bandages 3 days after surgery, and a healthcare professional may remove stitches 7–10 days after surgery. People may also have imaging scans, such as a CT scan.
The device will be in place for around a month after surgery before a doctor turns it on.
People may experience side effects of DBS during stimulation, which may include:
- temporary tingling in limbs or the face
- a pulling sensation in the muscles
- speech or vision problems
- loss of balance
- postsurgery headache
- gait problems, instability, and falls
- speech disorders
- cognitive changes involving working memory, attention, learning, processing speed, and verbal fluency
- impulse control
According to the Epilepsy Foundation, DBS may reduce seizure frequency in around half of cases. The technique may also help reduce seizure severity, and these seizures may improve over time.
It may take up to 2 years for DBS to have a beneficial effect on seizures. People will still need to take AEDs alongside DBS, but over time, they could reduce their need for medication if DBS is effective.
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DBS may be a treatment option for epilepsy if AEDs and surgery are ineffective or unsuitable.
The method involves implanting electrodes and a stimulator into the body to deliver electrical pulses to certain areas of the brain involved in seizure activity.
DBS is not a cure for epilepsy, but alongside AEDs, it may help reduce seizure severity or frequency in around half of those who have the procedure.