Cook Children's is the first independent pediatric hospital in the United States, and the only children's hospital in Texas, to offer a comprehensive movement disorder program that includes deep brain stimulation (DBS).
Now, we are the first pediatric hospital in the nation to offer DBS on sleeping patients.
Deep brain stimulation, or DBS, is a system that allows the doctor to place tiny electrodes into the brain. The electrodes are connected to an implanted medical device – sometimes referred to as a brain pacemaker – that delivers continuous low-voltage electrical impulses to the targeted part of the brain. These pulses block the abnormal firing of neurons in the targeted area providing relief for patients whose symptoms are not properly controlled by medication.
DBS is used to restore normal function in patients with physiological and movement disorders such as essential tremor and dystonia. The goal of DBS is to reduce muscle tone, improve function and prevent the progression of movement disorders to other areas of the body.
Successful DBS surgery can make considerable improvements to a patient's quality of life, with changes occurring three to six months after activation of the system
Why choose Cook Children's
"DBS doesn't change the way children think or act. But it does stop unwanted neurological impulses that cause involuntary movement." - John Honeycutt, M.D.
Imagine putting your arms out and your leg pops up, even though you didn't intend it to. Or trying to make your left leg stay still, but it won't, no matter how much you will it to. Children with dystonia experience all kinds of involuntary movement, and it is often combined with extremely painful muscle contortions, all of which can interfere with even the simple tasks most of us take for granted such as talking, walking, dressing ... even eating. Dystonia and similar movement disorders such as essential tremor can be very, very frustrating for adult patients, and even more so for a child.
Cook Children's offers one of the most recognized pediatric DBS programs available. For many children that we see, DBS surgery can reduce and, in many cases, restore movement, helping our patients to overcome lifelong obstacles.
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How is DBS surgery performed?
At Cook Children's, deep brain stimulation patients have both the electrodes and brain pacemaker placed during the same surgery, meaning they only undergo a single session of anesthesia, one hospitalization and one successful operation.
Deep brain stimulation surgery involves two parts: implanting electrodes into the brain and a pacemaker under the skin of the chest. The two devices are connected by the surgeon and electrical impulses are sent from the pacemaker to the brain to correct the abnormal impulses of the movement disorder. At many other hospitals the devices are implanted in two different surgeries and then connected. At Cook Children's, the devices are placed at the same time so the child only has to undergo one surgery.
If your child is undergoing awake DBS surgery, anesthesia is administered during some parts of the surgery. However, during other segments, your child will be awake so that the doctors can test his or her responses to the impulses.
Some children may need to remain asleep during DBS. If that's the case, your child may undergo real-time neurosurgical image guidance and procedure visualization – we call this "asleep" DBS surgery. This is the latest advancement in movement disorder treatments because it means that children who were unable to have 'awake' surgery, may now be candidates for DBS thanks to this new technology.
During the procedure:
- Your child's head rests in the iMRI head coil and fixation frame, while an MRI-visible grid
matrix is applied.
- High resolution images are generated by the MRI scanner and sent to the image guidance workstation for the doctor to review and select the neurological target.
- The image guidance software allows the doctor to find an optimal trajectory from the surface of the skull down to the neurological target in the brain, visualizing critical structures to be avoided.
- The grid matrix uses digital intelligence to identify specific coordinates of the entry point for the doctor.
- Once the entry point is created, a smart frame is attached to the patient's head, to help the doctor reaffirm the location of the neurological target and align the trajectory.
- As the surgeon inserts the interventional device through the center lumen of the trajectory frame, real-time images ensure no undesirable events have taken place and the target has been reached.
After awake or asleep surgery, your child will stay at the medical center for a few days then return home. In two weeks, you will return to the medical center where your doctor will turn on the stimulation devices, and adjust them. Over the next few months your child's muscle control will gradually improve and soon they will begin overcome some, if not all, of the difficulties they have experienced for years. It is important to note that DBS patients require regular visits to the medical center for ongoing adjustments to the pacemaker. While this can be time consuming, and create some hardship for patients and families who come from long distances, the benefits for your child can far outweigh the inconveniences.
From diagnosis through rehab in our Movement Disorders clinic, Cook Children's neurosciences team works closely with the patient, the family, and the child's physician to ensure the very best outcome possible.
Since the first implant in 2007, Cook Children's has established itself as one of the elite DBS programs in the nation with a dedicated team including:
- Neurologist with movement disorder experience
- Neurosurgeon with experience in stereotactic localization (operating on a small target)
- Patient liaison
- Physical therapists
- Occupational therapists
- Operating room support
- Skilled nurses
- Anesthesiologists
- Child Life specialists
- iMRI technicians
- Radiologists
- Neuropsychologists
