Epileptic Seizures Can Now Be Controlled With Deep Brain Stimulation Procedure
Dibyanshu, 12 years old boy from Orissa, started suffering from epileptic seizures since birth. Ever since, he had at least 5-10 seizures almost daily. His parents, worried had consulted various doctors across India for treatment. But until the age of 12 years, Dibyanshu was under medication and the seizures would not stop but only delayed. The frequency of the seizures was occurring after two to three days but did not subside.
Since he had been under medication for over 12 years, the body might have become resistant to medication and due to the result; the seizures had increased to 15 per day.
After being dejected from top hospitals for treatment, the patient was referred to Artemis Hospital as the last hope. The neurology team Comprising of Dr Sumit Singh, Dr Aditya Gupta and Dr Amit Aggarwal, analyzed the patient and upon complete investigation, the patient was referred for Deep Brain Stimulation (DBS). This surgery is being performed only for the 12th time in India and 5th by the Neurology team at Agrim institute of Neurosciences at Artemis Hospital.
To diagnose the exact location of the brain that generates the epileptic attacks, MRI, PET and CT scan of the patient is performed
Usually, the surgery for epilepsy consists of removal of a portion of the brain where the abnormality is found. Multiple tests like MRI, EEG and PET scans were done to diagnose the affected areas of the brain that triggered seizures. The investigation reports revealed that the seizures were triggered from different portions of the brain, medically known as multi-focal epilepsy, and removal of all the affected parts of the brain was not possible. Hence the team decided to perform Deep Brain Stimulation surgery. Understanding the criticality of the patient, immediate surgery was suggested to the patient's parents. This surgical procedure is helpful in cases where the effects of medications stop working.
Until now this surgery has been proven clinically to have the best results in treating Dystonia and Parkinson's disease. But in India, DBS is very rarely used to treat patients suffering from epileptic seizures. The procedure involved implanting electrodes in the specific parts of the brain that directly connects to a pacemaker. This pacemaker maintains and controls the minimum current of the brain that helps the central part of the brain to prevent seizures. This pacemaker is almost similar to what is used for heart. After the successful implantation, the patient was observed for 2 days and had shown complete results. No adverse events like bleeding in the brain, infection, depression or memory problems were seen. The patient had never ever had any attacks thereafter and is back to his normal life.
What is Deep Brain Stimulation (DBS)?
In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and completely remove the seizure.
Deep brain stimulation is most often offered to people when the effect of medications has completely stopped working for them and the number of seizures is more than 15 per day.
Understanding the DBS Functioning
The DBS system consists of 3 parts Lead, Extension and a Neurostimulator.
. Lead a thin insulated wire which is implanted in a small opening in skull. This wire reaches to the specific part of the brain where the epileptic activity happens. Our brain is active all the time and seizure attacks occur when there is a sudden burst of intense electrical activity.
2. Extension An insulated wire that is connected to the neurostimulator and is passed under the skin of the head, neck and shoulder.
3. Neurostimulator A device known as a pacemaker is placed inside the skin of chest, preferably under the collarbone. This device is used to control and sent the minimum signal required for the normal functioning of the brain. It is a small, battery-powered device that sends electrical impulses to the brain. These impulses travel through leads to electrodes which are placed in the anterior nucleus of the thalamus. Thalamus is the part of brain which is responsible for the spread of seizures.
To diagnose the exact location of the brain that generates the epileptic attacks, MRI, PET and CT scan of the patient is performed. Then the surgery is performed in two phases. In the first phase, two electrodes are implanted in the affected part of the brain through small incisions made in the skull. The placement of the leads is monitored on image guidance system for accuracy and precision. In the second phase, the neurostimulator is placed under the skin of the collarbone and the extension connects it to the leads.
DBS Works Where Medicines Doesn't
DBS is preferred only when the effects of medication tend to stop functioning. Over a period of time the effect of the medicines on the body tends to stop and hence the frequency of medicine intake increases. If a patient is prescribed to take the medicine thrice a day, then due to the loss of effect, they might need it more than 8 times a day. This affects their quality of life as they tend to get on and off that many times. This is where DBS surgery is beneficial as it stimulates that part of the brain which generates the seizure attack. What DBS does is that it provides a constant effect on the patient for 24 hours thereby stabilizing the quality of life.