Treatment of Cervical Dystonia of Deep Brain Stimulation (DBS)

Dystonia is the third most common form of movement disorders after Parkinson's disease and essential tremor. Dystonic syndromes are characterized by a disabling painful motor defects with violent movements and the formation of pathological postures. Cervical dystonia causes muscle cramps in the cervical region.

The pathology sharply limits personal adjustment, performance and social activities. It is very difficult to treat. The symptoms of the focal form of the disease can be eliminated by the injections of botulinum toxin. When treating generalized forms, drug therapy is usually ineffective. Only rare forms of cervical dystonia can be treated using levodopa.

Therefore, deep brain stimulation becomes the best option for many patients. It allows achieving a long-term alleviation of symptoms with minimal traumatization during the surgical procedure.

What is deep brain stimulation?

When performing a surgical procedure, a surgeon places an electrode in the target area of the brain. The intervention is performed using a stereotactic method. This means that the surgical procedure requires special equipment that sets the exact coordinates of a certain area of the brain followed by the necessary manipulations – in this case, the implantation of a device for brain stimulation becomes such a manipulation.

Deep brain stimulation (DBS) can be used not only for the treatment of cervical dystonia, but also for movement disorders of a different origin. Depending on the disease diagnosed in the patient, the peculiarities of the clinical picture and the data of instrumental studies, the area of the brain that should be subjected to stimulation DBS is determined.

Here are some of the main areas of the brain, in which the electrode is usually placed to stimulate the brain:

• Internal segment of the globus pallidus
• Ventral lateral nucleus of the thalamus
• Zona incerta
• Subthalamic nucleus

Deep brain stimulation modulates activity of the extrapyramidal system. It normalizes connections between different areas of the brain. As a result, a positive effect of stimulation DBS for movement disorders is achieved due to the normalization of the "brain rhythm". DBS actually imposes on the neurons (nerve cells) a new, correct rhythm.

DBS effects on target areas of the brain are achieved through stereotactic devices, atlases, and navigation programs. They allow to accurately localize the target in a three-dimensional coordinate system and reach it with using minimally invasive surgical techniques, without affecting the nervous tissue.

Deep brain stimulation is considered a functional treatment method for cervical dystonia. Unlike destructive operations, brain stimulation usually does not cause severe complications and neurological disorders. DBS is a sparing, but at the same time effective treatment for cervical dystonia.

How is brain stimulation performed?

Deep brain stimulation involves a surgical procedure to place an electrode. It is placed in subcortical structures.

The electrode is fixed to the bones of the skull. It is connected by a connector to a pulse generator. It is also called a neurostimulator. It is this device that generates impulses for deep brain stimulation. A neurostimulator for DBS is placed under the skin, in the area of the clavicle.

The device must be adjusted. The brain stimulation program is selected individually. The doctor performs the initial setup of deep brain stimulation device. In the future, the DBS program will be adjusted to achieve a better result. Modern brain stimulation devices can be adjusted even by the patient himself. This makes the fight against the disease more effective and more convenient, because if a person is undergoing treatment abroad, he usually cannot visit the hospital, where an electrode for stimulation DBS was implanted, too often. A doctor will teach him how to set up a program. The patient can independently adjust some parameters of deep brain stimulation, such as pulse amplitude, frequency and duration.

How does the procedure alleviate symptoms? 

The mechanism of the therapeutic effect of deep brain stimulation is still not understood fully. It is assumed that DBS works by imposing the correct "brain rhythm" on neurons. Thus, stimulation DBS acts as an artificial pacemaker. It provides desynchronization of the pathological rhythm in sensorimotor circles.

Here are some of the additional mechanisms of the influence of deep brain stimulation on the function of the central nervous system: 

• Increased synthesis of adenosine triphosphate followed by the accumulation of adenosine, which activates A1 receptors and inhibits the exciting neurotransmission in the thalamus
• Releasing peptide growth factors under the influence of DBS

Is brain stimulation dangerous?

Any surgical procedure on the different areas of the brain is more or less dangerous. Deep brain stimulation involves a neurosurgical intervention, and therefore it can cause complications.

However, if you are undergoing treatment abroad, in the best clinics in the world, then the health risks are minimal. The patients who are candidates for deep brain stimulation are selected carefully. They are examined, and in case of a high surgical risk DBS will be canceled. It is important that a person’s state of health allows him to undergo surgery and effectively interact with doctors when he wakes up from anesthesia during test brain stimulation.

Here are some diseases and conditions that may become contraindications for deep brain stimulation: 

• Anticoagulant therapy or coagulopathies that increase the risk of bleeding
• Immunodeficiencies or taking immunosuppressive drugs

• Diabetes mellitus
• Atrophy of the substance of the different areas of the brain
• Implanted pacemaker (reduces the effectiveness of DBS due to the resonance effect during brain stimulation)
• Age over 70 years

Most of these pathologies are relative, and not absolute contraindications to the use of DBS. This means that even this category of patients can undergo deep brain stimulation, but only under certain circumstances. Nonetheless, the surgical risks of DBS will be higher for them. Some patients can undergo deep brain stimulation only after a course of therapy and compensation of the existing chronic diseases.

Peculiarities of brain stimulation for dystonia

The focal forms of dystonia can be alleviated with botulinum toxin, but severe segmental and generalized forms require the use of bilateral deep brain stimulation. In fact, DBS remains the only method of real medical help to such patients who have impaired walking and self-care skills.

The main targets for deep brain stimulation are: 

• Internal segment of the globus pallidus
• VIM of the thalamus – in the case of a predominance of dystonic tremor

Internal pallidum deep brain stimulation for dystonia should be intensive. This DBS quickly depletes the battery, which requires replacement or recharging every 2-3 years.

Some patients with dystonia suffer from tremor. They have deep brain stimulation in the VIM of the thalamus, accompanied by a complete regression of this symptom. However, tremor will occur again after DBS completion. Some patients with this disease turn off the device to stimulate the brain for most of the day. They turn it on only in case of the necessity to perform work requiring fine motor skills.

Benefits of brain stimulation abroad 

Deep brain stimulation is now performed in many countries around the world. Brain stimulation in the best clinics is more efficient and safe. Some patients from developed countries go abroad in search of an affordable cost of treatment, because the price of deep brain stimulation in their own country may be too high.

The main benefits of brain stimulation abroad:

Diagnostics. The doctors at the best Neurology Centers will carefully examine you to see if deep brain stimulation will be safe and effective.

Selection of patients. The doctors will not perform surgery, if they decide that it can lead to complications or brain stimulation will not be effective enough.

Safety. The doctors conduct test brain stimulation, use state-of-the-art technology to determine functionally important areas of the brain, use minimally invasive methods for implanting electrodes, and use drugs to prevent complications.

Efficiency. The specialists from the best clinics in the world have vast experience in conducting deep brain stimulation. Therefore, they achieve better results in the treatment of dystonia with this surgical procedure.

Cost of treatment. The price of the procedure is significantly different in various countries. You can go to a country where the cost of treatment for dystonia with deep brain stimulation will be affordable for you.

How to undergo brain stimulation abroad?

To undergo treatment abroad for cervical dystonia or other forms of the disease, you can use the services of Booking Health. We will reduce the cost of treatment for you, help you choose a clinic for DBS, and make treatment abroad not only affordable, but also comfortable. You will not have to deal with the organization of a trip abroad to have deep brain stimulation – we will take care of all the organizational issues.

When cooperating with Booking Health, you will get many benefits:

• Selection of the best clinic for treatment abroad, which specializes in deep brain stimulation

• Direct communication with the doctor who conducts DBS
• Reduced waiting time for the start of treatment abroad, appointment for brain stimulation on the most suitable dates
• Reduced cost of treatment abroad – prices will be reduced due to avoiding additional coefficients for foreign patients
• Price control and return of unspent funds 
• You will get an insurance, so the cost of treatment will not increase even in case of complications of brain stimulation
• Preparation of deep brain stimulation program without the need to repeat previous diagnostic examinations
• Buying and forwarding medicines
• Communication with the hospital upon brain stimulation program completion
• Organization of additional diagnostics, treatment or rehabilitation for dystonia or other diseases of the nervous system

The Booking Health specialists provide high quality services. We will book a hotel and airline tickets for you, meet you at the airport and take you to the hospital by car, where you will undergo deep brain stimulation for an affordable price.