Deep brain stimulation (DBS) has been used for several decades to treat Parkinson’s disease and other movement disorders, but it was only approved by the Federal Drug Administration to treat seizures in 2018. As a comprehensive Level 4 epilepsy center accredited by the National Association of Epilepsy Centers (NAEC), UK HealthCare provides the most complex diagnostics and treatments in the region. Surgeons at UK HealthCare performed the first DBS procedure for a Kentucky seizure patient in February 2019, and to date, six patients have had the device implanted, with more to come.
The procedure, which is a type of neurostimulation device implant, is an option for patients whose seizures cannot be controlled after trying two or more medications, also called drug-resistant epilepsy, says director of UK HealthCare’s Epilepsy Program Meriem K. Bensalem-Owen, MD. Other eligible patients include those who are not candidates for focal resection surgery, which removes the part of the brain where the seizures start, or other neurostimulation device implants, including vagus nerve stimulation (VNS) and responsive neurostimulation (RNS).
DBS implantation is a two-step process. First, the neurosurgeon implants a battery-powered neurostimulator into the chest. Then in a separate procedure the surgeon uses imaging to guide the insertion of small electrodes into the brain. The electrodes are connected to the generator via thin wires. The two procedures are usually done within one week.
Doctors program the DBS device so it can send signals to the electrodes to stop seizures or prevent them from spreading. Over time the device changes how the brain cells work, which is referred to as neuro-modulation, says Bensalem-Owen. However, it can take a while for the brain to respond to DBS, so patients return to the Kentucky Neuroscience Institute (KNI) Epilepsy Clinic every three months or so to allow doctors to adjust the device settings and monitor for any side effects.
While patients here at UK HealthCare are still adjusting to the therapy delivered with this device, Bensalem-Owen notes they have seen a drop in the number of seizures, as well as shortened seizures and a faster recovery time following a seizure.
“It’s too soon to know the full effect of DBS in terms of seizure control in the recently implanted patients, but it does have the potential to improve patients’ quality of life. We have some patients that are very happy,” Bensalem-Owen says. “We have patients who didn’t have response with other treatments or patients who can’t have other treatments, so I think it’s very exciting that we have this additional therapy to offer them. These are tough patients to treat and it always breaks my heart when we have to wait for the next therapy to come. It’s nice to know that we have now another promising therapeutic modality.”