Deep brain stimulation, or DBS, is a highly successful therapy for Parkinson’s disease and essential tremor. Dr. Taghva is a regional expert in DBS and is unique among neurosurgeons in that he has specialized fellowship training in this procedure, whereas many practitioners of DBS do not have specialized training and are therefore limited in the options they can offer patients.
Dr. Taghva has performed hundreds of DBS implants, and was the first neurosurgeon in Orange County to perform DBS for epilepsy. He has experience with and routinely implants devices from Abbott, Boston Scientific, and Medtronic and is able to help patients choose the device that may be right for them. He is a leading surgeon advocate for “directional lead placement,” where highly specialized DBS leads that can steer electrical stimulation are implanted, and he has found that this gives patients better results with fewer side effects. In addition, Dr. Taghva is Orange County’s top implanter of “asleep” DBS for Parkinson’s disease, where patients can be comfortable under anesthesia and DBS lead placement is confirmed with highly sophisticated intraoperative imaging. Because of this multimodal approach, accuracy of DBS placement in his hands exceeds those of traditional awake lead placement – where patients are awake during the DBS procedure.
Dr. Taghva’s DBS patients are among the happiest in his practice and are regional advocates for the therapy. His patients have been featured in magazines such as Health Matters as success stories for DBS. DBS is covered by Medicare and most private insurances. Dr. Taghva received his medical degree at Johns Hopkins University School of Medicine, his residency at the University of Southern California with fellowship training at The Ohio State University. He is a board-certified neurosurgeon and has been voted by his peers as a Orange County Physician of Excellence consecutively for the past six years as well as being voted a Super Doctors Rising Star.
Board-certified neurosurgeon, Alexander Taghva, M.D., F.A.A.N.S., offers a unique corrective surgical treatment to directly target problematic brain impulses with deep brain stimulation in Mission Viejo, CA. Patients who have not experienced symptom relief using more conventional treatment methods for conditions such as Parkinson’s or epilepsy may be candidates for the procedure.
- What is Deep Brain Stimulation?
- When Deep Brain Stimulation is Recommended
- Who is a Candidate for Deep Brain Stimulation?
- A Deep Brain Stimulation Consultation in Orange County, CA
- Preparing for Deep Brain Stimulation Surgery
- How Deep Brain Stimulation is Performed
- Deep Brain Stimulation Recovery
- What Are the Possible Side Effects or Risks of Surgery?
- Why Choose Dr. Taghva for Deep Brain Stimulation?
- Frequently Asked Questions About Deep Brain Stimulation
What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a type of neurosurgery that is performed to improve certain medical conditions by delivering electrical impulses to a specific area of the brain tissue in order to target abnormal activity. The procedure is often described as a “pacemaker” for the brain and is most commonly performed during two separate surgeries.
During DBS surgery in Mission Viejo, a neurostimulator device system is inserted into the brain through a small opening in the skull. The surgeon is guided with imaging provided by magnetic resonance imaging (MRI), CT scanning, or a computer program. Dr. Taghva implants wire electrodes into the side of the brain on both the left and right, targeting parts of the brain where problematic impulses are generated. The electrodes are held in place by small disks that are secured on top of the brain.
At a later date, wire leads are connected to the electrodes and placed below the skin, following the curvature of the head and neck. The wires are connected to a pulse generator that is secured in the chest wall, below the collarbone.
Patients may be sedated and given local anesthesia, but since the brain does not contain any pain receptors, they can remain conscious during the procedure. This helps the neurosurgeon recognize the real-time effects of the surgery. Some neurosurgeons choose to perform a different version of DBS surgery while patients are fully asleep.
Three to six weeks later, patients will return to the operating room to undergo the placement of the pulse generator. This procedure is typically completed on an outpatient basis. During another appointment, the patient’s DBS system can be programmed to deliver the type of electrical signals that will be most beneficial for the patient’s condition.
When Deep Brain Stimulation is Recommended
There are many different diseases and conditions that can affect the brain and influence a patient’s quality of life. Following successful clinical trials, the FDA has approved deep brain stimulation for the following conditions:
- Parkinson’s disease and essential tremor – 1997
- Dystonia – 2003
- Obsessive-compulsive disorder – 2009
- Epilepsy – 2018
Generally, DBS surgery is recommended for individuals who have not responded to other types of treatments and whose symptoms are disruptive to everyday life. Deep brain stimulation helps patients find relief while avoiding the negative side effects of medication by interrupting harmful impulses through electrical stimulation delivered directly to the responsible brain cells.
DBS is still being studied to treat a range of other medical conditions. In the future, deep brain stimulation may be approved for multiple sclerosis and clinical depression.
Who is a Candidate for Deep Brain Stimulation?
Patients are selected for deep brain stimulation in Orange County on a case-by-case basis. Dr. Taghva evaluates each patient to determine the best course of treatment for their needs. DBS candidates in Mission Viejo typically fall into two categories: they are sufferers of either movement disorders or neuropsychiatric conditions.
A movement disorder results from a neurological issue like Parkinson’s disease, which creates involuntary movement and motor symptoms that disrupt a patient’s regular abilities and activities. Symptoms of Parkinson’s include tremor, bradykinesia (slower-than-normal movements), muscle rigidity, and poor balance or posture.
A patient’s quality of life diminishes significantly when they cannot control movement. Deep brain stimulation of the globus pallidus internus or subthalamic nucleus can treat isolated dystonia (uncontrolled muscle contractions) with or without tremors and with no additional neurological issues.
Neuropsychiatric conditions manifest as mental disorders that originate from the nervous system. Symptom control can also be offered to patients with disorders like obsessive-compulsive disorder (OCD) and Tourette syndrome through electrical impulses.
Those with dementia and severe untreated depression are not candidates for deep brain stimulation in Dr. Taghva’s Mission Viejo practice. DBS can worsen memory problems and lead to suicidal ideation. Once depression is treated, the surgery may be a good treatment option.
A Deep Brain Stimulation Consultation in Orange County, CA
Dr. Taghva evaluates each patient’s case carefully during a private consultation before recommending DBS or another treatment in Mission Viejo, CA. Patients who are eligible for this complex surgical procedure are generally those who are experiencing moderate to advanced symptoms of an approved DBS condition, have undergone treatments that were ineffective or find that their medication side effects are worsening, and meet the guidelines for a good surgical candidate.
The DBS consultation is lengthier than other procedures because preoperative evaluations are typically conducted as a series of tests. In many cases, patients may need to be evaluated both on and off their medications. Because DBS can treat numerous conditions, the prerequisites for surgery will differ from one patient to the next and assessment may involve consulting with several medical groups.
During a consultation at Orange County Neurosurgical Associates with Dr. Taghva, the neurosurgeon works with the patient to prepare an optimal treatment plan for a better quality of life. In some cases, the recommendation may include DBS surgery.
Preparing for Deep Brain Stimulation Surgery
Orange County deep brain stimulation may require rigorous testing prior to scheduling the procedure. Patients may be asked to discontinue their medications to determine the effects of their condition without prescriptions. In cases when patients are unable to or unwilling to discontinue medications, they may qualify for the version of DBS that is performed while the patient is asleep.
DBS patients should have a physical exam conducted by their primary care physician, blood tests, an electrocardiogram (EKG), and a chest X-ray. This helps Dr. Taghva determine that the patient is healthy enough for the procedure. Any chronic illnesses and related medications must be discussed before the procedure.
How Deep Brain Stimulation is Performed
Patients are typically awake during DBS surgery in Orange County, though a newer technique can be performed while the patient is anesthetized and asleep.
When the patient is conscious but lightly sedated for a calming effect, a frame is fitted onto the head to steady the area for surgery. Topical anesthesia (numbing) is used as pins penetrate the skin around the forehead and the back of the head with the framing device. With the frame in place, patients will have an MRI or computed tomography (CT) scan so that Dr. Taghva and his surgical team can visualize the brain in relation to the placement of the pins in the frame.
Computerized equipment, a mobile X-ray unit, and a robot are utilized to ensure accurate placement of the electrodes in the brain. Different pieces of equipment, like an arc, can be fitted to the frame on the head to aid in the precision of the surgery.
Once the electrodes are in place, the DBS system will be powered on so Dr. Taghva can view symptom changes and any side effects while adjusting the impulses. After the placement of the electrodes, another set of images will be captured to confirm proper placement.
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When deep brain stimulation is performed while the patient is fully asleep, the procedure is conducted inside of an MRI machine, which provides real-time visualization. While X-rays take still snapshots of the brain and can assist in visualizing the area before and after changes are made, an MRI provides continuous imaging.
An aiming device is placed on the scalp and enables visibility and adjustments to be made while the patient is in the MRI machine. The aiming device creates points that will show up on computerized equipment, allowing the neurosurgeon to plot the correct points for electrode placement.
Deep Brain Stimulation Recovery
After deep brain stimulation is performed in Mission Viejo, patients will undergo a healing process that is unique to their situation.
Directly after surgery, patients may feel some discomfort in their head, but because the brain does not contain any pain receptors, only the incision and frame pin sites will be sore. Dr. Taghva will prescribe any necessary pain medications prior to the surgery.
Patients may also feel some discomfort at the site of the pulse generator for a period of time. With an adjusted medication regimen and the initial programming of the device, patients may notice different sensations or muscle movements.
Four to six weeks postoperatively, the team can begin programming the system. It can take a few to several months to adjust the settings of the DBS generator for the best results. Patients must adhere to any restrictions provided by Dr. Taghva for the safest recovery and best results.
What Are the Possible Side Effects or Risks of Surgery?
While Dr. Taghva takes every precaution possible, there are inherent risks involved with deep brain stimulation. Side effects may also occur. Patients can discuss any concerns about deep brain stimulation at Orange County Neurological Associates with Dr. Taghva during their consultation. Risks may include:
|Stroke||Hemorrhage||DBS system malfunctions|
|Adverse effects of stimulation||Worsening memory||Suicidal ideation|
Why Choose Dr. Taghva for Deep Brain Stimulation?
Alexander Taghva, M.D., F.A.A.N.S. is board certified in neurosurgery and is an expert in deep brain stimulation surgery, Parkinson’s disease, and minimally invasive spine surgery.
The doctor completed his undergraduate education at the University of Southern California and graduated summa cum laude with a biochemistry degree. He attended Johns Hopkins University School of Medicine and completed a neurological surgery residency program at the University of Southern California. Dr. Taghva went on to complete a fellowship in neuromodulation and functional neurosurgery at Ohio State University.
The doctor maintains memberships in a number of professional groups and practices modern neurological surgery techniques. Read more about Dr. Taghva here.
Frequently Asked Questions About Deep Brain Stimulation
Deep brain stimulation is considered reversible. Predecessors to the procedure sometimes damaged patients’ brain tissue with heat, but thanks to advances in the field of neurosurgery and improved technology, DBS can be a permanent but reversible treatment option.
Younger patients are generally better candidates for any surgery, and DBS is no exception. Some patients may opt to undergo the procedure when they have moderate effects, knowing that they have a progressive disease.
Healthy older individuals with moderate to advanced conditions might also determine that DBS surgery would benefit them. Each patient should discuss the timing of the procedure with Dr. Taghva as each individual situation is unique.
Deep brain stimulation should not be thought of as a means to cure or slow the progress of a condition or disease, but rather as a way to manage its symptoms. Most patients will need to continue their medication regimen, but their dosages can be adjusted based on the efficacy of the DBS system. With some conditions, full relief can be noticed after 3-6 months.
Even with advances in medicine, there is still much we do not know about the brain. Previously, it was thought that the signals in the brain were entirely blocked during DBS, but it is now suggested that neurons continue to fire, but the signal of information is somehow prevented from completing the transfer of electrical information that leads to certain symptoms.
The thalamus, subthalamic nucleus, and globus pallidus are three common areas of the brain that can be targeted for tremors and other symptoms brought on by Parkinson’s.
Mission Viejo neurosurgeon Dr. Alexander Taghva specializes in deep brain stimulation as well as minimally invasive spine surgery known as spinal cord stimulation, or SCS. Using the same technology, electrodes affect nerve structures in the spinal cord to manage pain, and a controllable pulse generator is implanted in the chest wall below the collarbone.
Rather than delivering electricity to pace the heartbeat, these devices deliver electricity to interfere with nerve signals. Both the SCS and the DBS systems are highly customizable and will be programmed by experts with patient feedback.
Dr. Taghva is proud to offer patients innovative treatments like deep brain stimulation in Mission Viejo, CA, to improve their quality of life. To schedule an appointment, call (949) 388-7190 today.