Functional Neurosurgery Reduces Symptoms for Patients with Movement Disorders and Epilepsy

Functional Neurosurgery Reduces Symptoms for Patients with Movement Disorders and Epilepsy

Neurosurgeons at Brigham and Women's Hospital are using functional neurosurgical techniques, including deep brain stimulation, temporal lobectomy, vagus nerve stimulation, and advanced brain mapping techniques to decrease symptoms and improve quality-of-life for patients with movement disorders and epilepsy.Deep Brain StimulationBrigham and Women's Hospital is one of few centers in New England to offer Deep Brain Stimulation (DBS), which is currently used for select patients with Parkinson's disease, essential tremor, and dystonia.Team of ExpertsWilliam S. Anderson, MD, PhD, a neurosurgeon who is fellowship trained in functional neurosurgery, and Michael T. Hayes, MD, a neurologist who recently joined Brigham and Women's Hospital and has more than 17 years' experience treating patients with movement disorders, work as part of a multidisciplinary team of specialists in the Movement Disorder Program. In collaboration with neuropsychiatrists and other specialists in the Program, Dr. Hayes provides a comprehensive evaluation for prospective candidates for DBS, including a full review of medications and complete assessment of motor and cognitive functioning.Detailed magnetic resonance images are used prior to device implantation to coordinate targets. Microelectrode mapping and tracking of electrical cellular activity guide placement of probes, and testing of the system in the OR helps to ensure that placement is improving symptoms without adversely affecting other areas, such as language function. Dr. Hayes provides close post-surgical followup and adjustment of the implanted device to achieve the best clinical response, while reducing residual side effects.Expanded Use of DBSCommonly, DBS is most beneficial for treating tremor, motor fluctuation, and patients who do not tolerate medications well due to side effects. Traditionally reserved for patients in later stages of Parkinson's disease, DBS is being evaluated for patients earlier in the disease process, especially when medications become less effective in controlling symptoms.Reported Success RatesStudies of patients who have undergone DBS have shown:Up to an 80 percent decline in medication doses and similar declines in off-time and dyskinetic movements in patients with Parkinson's disease;A 51 percent average decline in symptoms 12 months following the procedure, as well as demonstrated functional improvements in quality-of-life, walking, hygiene and eating, among patients with dystonia;Eighty-one percent declines in tremor score among patients with essential tremor.Functional Neurosurgical Treatment for EpilepsyWorking as part of a multidisciplinary team of specialists in the Epilepsy and EEG Program, a Level IV Epilepsy Center, Alexandra J. Golby, MD, Director of Image-Guided Neurosurgery and Principal Investigator of the Surgical Brain Imaging Laboratory, neurosurgeon Joseph R. Madsen, MD, and Dr. Anderson perform innovative functional neurosurgical procedures using image guidance to reduce or eliminate symptoms for patients with epilepsy.Functional brain mapping, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), magnetoencephalography (MEG), and ictal SPECT, are used together to non-invasively localize seizure activity and identify areas of eloquent cortex related to critical function, including language, motor skills, and memory. These techniques are being combined with intraoperative electrococortical stimulation (ECS) and phase II epilepsy monitoring using intracranial electrophysiologic studies to perform more complete and precise resections, while preserving neurological functions.Neurosurgical techniques used to reduce or eliminate seizure activity include:Temporal lobectomy is used for partial seizures originating in the temporal lobe, a form of epilepsy that is difficult to control with medication. The procedure completely eliminates seizures in approximately 70 percent of appropriately selected patients, and an additional 20 percent of patients experience a reduction in seizure activity. Many patients also are able to reduce numbers and doses of medications, and some can eventually discontinue antiepileptic drugs;Extratemporal resections and disconnections are used for epilepsy originating from other areas of the brain, including epilepsy associated with brain tumors. Surgery often requires advanced studies to localize the source of the seizures and to define critical brain areaswhich may be involved. Individual treatment decisions and prognostic impressions are made based on analysis of integrated results from multiple tests;Vagus Nerve Stimulation (VNS) is used for patients with intractable generalized seizures to reduce the frequency and severity of symptoms and restore qualityof-life. VNS implantation generally reduces frequency of epileptic activity by 25 to 33 percent, which improves to approximately 40 percent one year following the procedure.Brigham and Women's Hospital's neuroscience center offers neurology services with the care & compassion you would expect from an organization that has been consistently ranked as one of America's best hospitals on the U.S. News & World Report Honor Roll, and one of the top neurology & neurosurgery providers in the country.

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