Deep brain stimulation in epilepsy

Deep brain stimulation (DBS) is an implantable device, similar to a pacemaker, that affects the electronic impulses of the brain. It is used to treat many neurological disorders, including epilepsy – a condition caused by abnormal electrical activity of neurons in the brain.

The DBS is placed under the patient’s collarbone during surgery. A connected electrode through which the required electrical impulse will be delivered is placed inside the brain. This surgery is considered safe and usually lasts 3-4 hours. In most medical centres, the patient remains conscious during the procedure.

After the surgery, the doctor will adjust the deep brain stimulation device to the individual electrical activity of the patient’s brain. It will deliver an electrical impulse at a programmed frequency that regulates the activity of neural networks. This is the most crucial part of the treatment, as it will determine the effectiveness of DBS. A big advantage compared to other treatment methods is the possibility of readjusting the device if the results are not sufficient or if the patient is concerned about side effects.

International medical organisations recommend deep brain stimulation for:

patients who have failed to achieve control of their epilepsy symptoms after taking at least two different anticonvulsant medications; 

patients with multifocal epilepsy; 

patients who have had 6 or more seizures per month for at least the last three months (with no more than 30 days between seizures). 

Epilepsy patients who fall under any of these criteria can contact their doctor to discuss treatment options. Deep brain stimulation is only one of them – VNS therapy, RNS therapy, surgical treatment, and stereotactic radiosurgery are also available for this condition. To understand which treatment option is best for the patient, a thorough diagnosis is necessary.

Studies that are prescribed to patients usually include EEG monitoring, brain MRI scans, and evaluation by a cognitive neuropsychologist. Additional tests may be ordered depending on the situation.

The actual effect of deep brain stimulation for epilepsy is difficult to predict. The outcome depends significantly on how the procedure is carried out – the medical team individually selects the area of the brain to be electrically stimulated and adjusts the device in each case. The doctor’s approach depends on the experience of the neurosurgeon and can vary from clinic to clinic. This is why choosing the right hospital for epilepsy treatment is so important.

With rare exceptions, epilepsy cannot be cured completely. However, DBS can meaningfully reduce the frequency of seizures and make the patient less reliant on anticonvulsant medications, which significantly improves the quality of life.

It is important to understand that the effect of this procedure will not come immediately – the frequency of seizures will gradually decrease over the next 2-5 years.

According to Dr. Robert Fisher, director of the Epilepsy Center at Stanford University, between 40% and 75% of patients manage to reduce the frequency of epi-seizures by undergoing deep brain stimulation.

Although DBS is not contraindicated in children, in most cases doctors favour VNS therapy (vagus nerve simulation). It performs well on paediatric patients and usually causes fewer side effects.

One exception to this rule is a 10-year-old boy from the US, Rylan Moll. The child began suffering from epilepsies at the age of 7 – the disease first manifested exactly on New Year’s Eve. The illness started unexpectedly and was severe – Rylan could experience up to 4 seizures in 24 hours for no apparent reason. Visualisation scans carried out in the emergency department also failed to reveal anything concrete.

The medication therapy that was immediately prescribed to the boy was not effective enough – the drugs helped for a few months and then the seizures returned. Because of constant absences from school, the boy began to fall behind academically, not to mention missing out on essential socialising with other children.

Rylan’s unique circumstances made him an ideal candidate for deep brain stimulation, despite his young age. Under MRI guidance, the surgeon fitted the boy with a DBS machine – with an electrode in the thalamus (an area of the brain) and a battery-powered generator under his ribs.

Among Turkish clinics, we can first of all recommend the Medicana Clinic. Professor Hakan Şimşek, a neurosurgeon with 25 years of experience, sees patients here. He underwent training, with a strong emphasis on the treatment of epilepsy, at the world-famous Johns Hopkins University Hospital. The price of DBS performed by this doctor starts from $27,000. Also among Turkish specialists, Prof Selçuk Peker (Koç Uniclinik) and Ali Zirh (Medipol Clinic) have achieved great success in treatment. Their treatment costs from $43,000 and $32,000 respectively. Patients also often go to Liv Istinye Clinic, where Dr. Baran Yilmaz performs DBS for epilepsy. The price of the procedure performed by him will start at $20,000.

One of the best epilepsy clinics in Spain is the Teknon University Hospital. Their Epileptology Centre has been operating for over 30 years and has been awarded the title of “Level 4 Centre” by the National Association of Epilepsy Centres (NAEC). The department is headed by some of Spain’s most renowned neurosurgeons, Professors Antonio Roussi (President of the Spanish Epilepsy League) and Bartolomé Oliver (who introduced Spain’s first Renishaw Neuromate robot for epilepsy surgery). DBS in this hospital costs from €38,000.