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When recurrent seizures aren’t responsive to traditional therapies, your doctor may recommend deep brain stimulation for epilepsy to help regulate electrical impulses in the brain and manage symptoms.
Epilepsy is a chronic neurological disorder of the brain. It causes recurrent seizures and episodes of involuntary, uncontrollable movements, sensations, and emotions.
There are many types of epilepsy syndromes. They all feature recurrent seizures as a primary symptom but are differentiated by type of seizure, cause, and accompanying symptoms.
When epilepsy isn’t responsive to traditional antiseizure medications and therapies, your doctor may suggest deep brain stimulation (DBS). For some people, DBS may help regulate erratic electrical impulses in the brain thought to underlie seizure activity.
While the exact causes of epilepsy aren’t fully understood, seizures themselves stem from temporary, unusual electrical activity in the brain.
Electrical signals in the brain are an essential component of central nervous system function and communication. They cue your neurons to release neurotransmitters, chemicals involved in everything from muscle movement to emotional regulation.
DBS influences the electrical impulses in your brain through surgically implanted electrodes. The electrodes help the brain regulate its electrical activity.
A surgeon places the electrodes in areas of the brain specific to the type of epilepsy you have. They connect the electrodes with wires to a neurostimulator device that acts as a battery and control hub for the implants.
DBS is then administered through one of two methods:
- the open-loop method, also known as the traditional method
- the closed-loop method, which is more advanced
In the open-loop method, the neurostimulator is programmed to continuously deliver electrical impulses to the brain at a set rate, pattern, and intensity for a specific amount of time.
The closed-loop method involves more real-time management of electrical impulses. Unlike in the open-loop method, the electrodes in closed-loop DBS can detect unusual electrical signals in the brain as they happen. When erratic signals are picked up, an external device calculates and adjusts the delivery of DBS based on exact readings from the brain.
Closed-loop DBS is still an emerging technology, but it holds promise for conditions like epilepsy where real-time management of electrical patterns might be more effective at managing unpredictable seizure activity.
DBS can be an effective option for reducing seizures in treatment-resistant epilepsy, though it may not be as successful at eliminating seizures completely.
Some people need to continue to take antiseizure medication after having DBS surgery for epilepsy. They may have better seizure control with medication than they did before the surgery.
According to a 2022 overview of research, long-term clinical trials show 69% of people see symptom improvement with DBS, but seizure-freedom rates are much lower at 6%.
Emerging evidence suggests that closed-loop DBS might be more effective at treating epilepsy than open-loop DBS.
A 2021 literature review suggests that closed-loop DBS for epilepsy allows for more dynamic management of the condition, which may improve overall quality of life.
In addition to being able to make real-time adjustments, closed-loop DBS may come with fewer side effects. It may offer improved technological features, like longer battery life and lower power consumption.
More research is necessary to determine the effectiveness of closed-loop versus open-loop DBS for epilepsy.
According to a 2016 study, the average cost of DBS implantation is around $39,000 in the United States.
The cost of your procedure will vary depending on many factors, such as:
- the type of epilepsy you have
- any preoperative testing you may need
- how your procedure is done
- your region and insurance coverage
Before you’re considered a candidate for this procedure, your doctor will have you try at least two traditional antiseizure medications. They may also ask you to participate in additional testing or meet with more specialists to ensure DBS is the right choice for you.
These tests, consultations, and medications add to overall costs, as will the follow-up care after your procedure.
As a chronic condition, epilepsy treatment qualifies for Medicare coverage. Your policy may cover DBS, but your doctor will need to provide supporting documents that show other traditional therapies have been tried without success.
Even then, Medicare may have additional requirements before approving DBS.
Many private insurance companies also offer DBS coverage, but your deductible and other financial obligations will depend on your policy.
DBS involves the surgical implantation of electrodes into areas of your brain experiencing seizure activity.
This is done under general anesthesia. It requires a surgeon to make small openings in your scalp and skull. If you have a neurostimulator placed under the skin, you may also have an incision by your collarbone or, for some people, at the chest or abdomen.
The neurotransmitter is placed at the same time as the electrodes or as a separate procedure 1–2 weeks later, depending on your surgeon.
Most people return home from the hospital 1 or 2 days after DBS surgery with surgical dressings covering the incision sites.
Protocol from UC Davis Health’s Deep Brain Stimulation Program recommends removing bandages on day 3. At this time, you can start showering again. You must be careful not to scrub your incision sites and use only mild shampoo, such as baby shampoo.
Non-dissolvable stitches are removed within 14 days after surgery.
It’s typical to experience swelling and pain at your surgical sites in the days after the procedure. Your doctor can prescribe pain medications or make an over-the-counter drug recommendation based on your level of discomfort.
Your DBS machine won’t be activated until approximately 4 weeks after surgery. Once DBS begins, you’ll visit your neurologist regularly to check the device’s performance, make adjustments, and track any symptom changes.
DBS is rarely a quick fix. Medtronic, a well-known manufacturer of DBS devices, says it can take several months or longer to dial in the best settings for seizure control.
Any side effects of DBS surgery are often mild and reversible. They can include:
During DBS, you may experience:
- muscle sensations
- speech or vision changes
- loss of balance
- tingling in the face of extremities
Deep brain stimulation (DBS) for epilepsy is an option when recurrent seizures aren’t responding to traditional therapies. Using electrodes implanted into specific brain areas, DBS helps regulate the electrical signals that underlie seizure activity.
DBS may not work for everyone with treatment-resistant epilepsy. It rarely stops seizures completely.
Your doctor can discuss the pros and cons of DBS for epilepsy with you. If you’re a candidate for the procedure, it can take several months after DBS activation before you notice significant improvements.