X RAY shows DBS probes in the brain 370.
(photo credit: Wikimedia Commons)
A patient with intractable epilepsy that has not improved with medications has
undergone implantation of electrodes deep in his brain to stimulate neurons and
halt his attacks. Prof. Itzak Fried of Sourasky Medical Center performed the
surgical treatment, which has been a success thus far. It is available in some
centers abroad but is not yet in the basket of health services, and has not been
attempted on patients at other medical centers with expertise in deep brain
Fried, the head of the functional neurosurgery unit at
the Tel Aviv hospital, said on Sunday, when the operation was announced, that he
used a DBS system made by the Medtronic company based in Switzerland.
is a new treatment for patients who suffer from severe epilepsy that does not
respond to medications.”
The hospital implants similar electrode systems
in patients with Parkinson’s disease, dystonia (a neurological movement disorder
in which continued muscle contractions cause twisting and repetitive movements
or abnormal postures) and primary tremor. However, the electrodes for
treating epilepsy are placed in a part of the brain different than the one
accessed to treat the other neurological disorders, Fried said.
electrodes are inserted through a small opening in the skull and implanted on
the two sides of the brain. During the surgery, electrical activity of the brain
cells in a specific nucleus is measured. The electrodes are connected to a
“pacemaker” implanted on the side of the chest cavity under the clavicle and is
controlled by an exterior remote control mechanism, Fried said. The implant is
left in the brain permanently.
About one percent of the population suffer
from epilepsy, a brain disorder that causes victims to suffer from repeated
These convulsions are episodes of disturbed brain activity that
cause changes in attention or behavior. Almost a third of patients’ seizures do
not respond well to medications.
In some patients, if the epilepsy is
caused by a tumor or other diseased tissue in the brain, it can be removed to
relieve the convulsions. However, in others, the cause of disturbed brain
activity is not a tumor or surgery would cause severe brain damage and thus
could not be performed. Thus, said Fried, DBS is a possible
There are some 60,000 epileptics in Israel, said Sourasky’s
EEG and epilepsy unit Prof. Miri Neufeld. The DBS treatment, she said,
opens the way for a new treatment for the 30% who have intractable
DBS for Parkinson’s and dystonia patients was pioneered in Israel
at Hadassah University Medical Center in Jerusalem’s Ein Kerem.
some 100,0000 such patients have undergone DBS implantation around the world,
including about 300 at Hadassah. Its leading DBS expert, Dr. Zvi Israel, told
The Jerusalem Post on Sunday that while DBS for Parkinson patients is widely
accepted, DBS for epilepsy is “more controversial.”
“It would be relevant
for a very small number of patients. Prof. Fried has performed conventional
surgery on epilepsy for years.
Our epilepsy program is almost two years
old. Ichilov has a track record for epilepsy surgery. The choice of patients for
DBS is key, and the problem is exactly where to locate the electrodes,” he
He added that there can always be complications with DBS implants,
including infections and hemorrhages. In addition to Medtronic, another company
named St. Jude Medical makes DBS systems, and it will soon be followed by Boston
Scientific, Israel said.
“I don’t think DBS for intractable epilepsy will
take off quickly any time soon. In the past, DBS for Parkinson’s was added to
the basket of health services only when it was already performed on 25
patients,” he continued.
Hadassah has performed DBS on patients with
intractable depression and Tourette’s syndrome. The procedure was made possible
through the work of Prof. Hagai Bergman, president of the International Basal
Ganglia Society and a researcher at the Hebrew University’s Interdisciplinary
Center for Neural Computation and the Edmond and Lily Safra Center for Brain
Research. Israel said Bergman has been tipped to win a Nobel Prize in Medicine
and Physiology for his groundbreaking work.
The Hadassah expert said he
and his colleagues are currently working on using DBS to treat schizophrenia in
primates, even though the animal model is not identical to the human psychiatric
disorder. DBS is also being tested abroad on intractable depression and
obsessive-compulsive disorder that does not respond to medication.