Deep Brain Stimulation FAQs
What is asleep DBS?
Asleep DBS is a surgical procedure for placement of deep brain stimulating electrodes while you sleep under general anesthesia. The ClearPoint® surgical navigation system is used in conjunction with live MRI guidance at the time of surgery to assist in the accurate placement of your DBS electrodes at a target location. MRI produces high-quality images that give your surgeon a detailed look at the substructures of your brain, and it does not expose you to the radiation inherent with other imaging methods, like computed tomography (CT) scans, so your surgeon can rely on continual MRI scans of your brain through the entire procedure to guide the surgery.
What are the differences between asleep DBS and awake DBS?
During awake DBS your surgeon uses a local anesthetic to numb your scalp for the incision, and you are given a mild sedative to help ease any anxiety. Tiny recording electrodes are then inserted into your brain to map the path and location of the target. If you have Parkinson’s disease you may be required to abstain from your medications to avoid disrupting these cellular recordings. Once your surgeon is sure of the best path and location for your DBS electrodes, they are inserted and placed at the specified location.
The idea of being awake and off medications during brain surgery troubles some patients. Other patients have physical restrictions that make an awake surgery challenging. Asleep DBS with the ClearPoint® system allows you to be placed under general anesthesia during the entire procedure and does not require you to stop taking your medications before the surgery. Your surgeon will use live MRI images to guide the surgery, which can also eliminate the need for cellular recording.
What happens during an asleep DBS procedure?
You will first be placed under general anesthesia. Your entire procedure will take place in a MRI scanner suite where you will be lying flat on a scanner bed, asleep. Your surgeon will attach a small instrument holder to your head and take a MRI image of your brain to identify the optimal entry point and target for the DBS electrodes.
Your surgeon will next take additional MRI images while using the ClearPoint® system to determine the optimal pathway to reach the target. After the DBS electrodes are placed, the ClearPoint® system will be used again to verify that the electrodes are accurately positioned at the planned target.
Once your surgeon confirms accurate placement of your DBS electrodes, the lead wires will be fitted under your scalp in preparation for connection to the generator device. After the initial surgery, the generator will be connected and positioned under your collarbone.
What are the advantages of asleep over awake DBS?
Asleep DBS improves the patient experience by allowing you to literally ‘sleep’ through your surgery. Some other benefits include:
- Patients with Parkinson’s disease can continue taking their medications up to the day of surgery
- Procedure times are reduced significantly
- Cellular recordings may no longer be necessary, reducing time and the number of additional passes into the brain
- Real time visualization allows your surgeon to ensure precise and accurate placement of your electrodes, minimizing the possibility of a second procedure
This differs from awake DBS surgery in which the patient is kept conscious during the operation and refrains from taking medications on the day of surgery, which can be very uncomfortable for some patients. Without live MRI imaging your surgeon depends on your feedback to determine the best possible location for the electrodes and to minimize side effects related to the stimulation.
What are the benefits of awake DBS over asleep DBS?
Asleep DBS with ClearPoint® is an innovative application of MRI in medicine, expanding its established use in diagnosing illness and injury to now include real-time MRI guidance in surgical procedures. Many surgeons have more experience performing traditional DBS; however, ClearPoint® allows your surgeon to see live images of your brain during the procedure, offering advantages that traditional DBS techniques cannot and suggesting a potential shift in the standard of care toward the asleep procedure.
Does asleep DBS produce better outcomes than awake DBS?
Asleep DBS has shown great potential in improving the patient experience, and published results indicate that outcomes are similar to the best outcomes reported with awake procedures. Asleep DBS has been shown to be highly accurate, in part because your surgeon can see exactly where the DBS lead is being placed.
The ClearPoint® neurosurgical system was developed in 2008 by leading neurosurgeons at the University of California, San Francisco. Dr. Phil Starr, Dr. Paul Larson, and Alastair Martin, PhD. pioneered the asleep DBS procedure using MRI imaging, allowing them to see inside the brain in real-time and eliminating the need for a patient to remain awake.
What conditions are treated with asleep DBS?
Asleep DBS is used to treat movement disorders such as Parkinson’s disease and dystonia in adults and pediatric dystonia in children. As research reveals the effectiveness and utility of asleep DBS, Henry Ford Health System may extend its use to other neurological disorders.