The specialist: Co-director of the Center for Neuromodulation
at Mount Sinai, Dr. Brian Kopell is a neurosurgeon who specializes in implanting devices to alleviate chronic pain, psychiatric disorders andmovement disorders like Parkinson’s. He performs 200 to 300 neuromodulation surgeries a year.
Who’s at risk:
Millions of Americans live with neurological disorders that arise from abnormal firing of the circuits of the nervous system, which can lead to a wide range of debilitating symptoms.
“Neuromodulation therapies are a new field of treatment that involves stimulating parts of the nervous system to alter or reset the abnormal circuitry,” says Kopell. “By implanting devices in the affected area of the body, we can use electricity or drugs to alter the problematic circuitry — much in the same way that a pacemaker controls abnormal heart rhythms.”
at Mount Sinai, Dr. Brian Kopell is a neurosurgeon who specializes in implanting devices to alleviate chronic pain, psychiatric disorders andmovement disorders like Parkinson’s. He performs 200 to 300 neuromodulation surgeries a year.
Who’s at risk:
Millions of Americans live with neurological disorders that arise from abnormal firing of the circuits of the nervous system, which can lead to a wide range of debilitating symptoms.
“Neuromodulation therapies are a new field of treatment that involves stimulating parts of the nervous system to alter or reset the abnormal circuitry,” says Kopell. “By implanting devices in the affected area of the body, we can use electricity or drugs to alter the problematic circuitry — much in the same way that a pacemaker controls abnormal heart rhythms.”
There’s a reason that the language neurologists use sounds like the way your electrician explains the wiring in your house. “In essence, the nervous system is an electrical entity,” says Kopell. “All your thoughts, your feelings and often your symptoms are the result of electrical phenomena traveling around the brain, the nerves and the spinal cord — and neuromodulation seeks to fix problems that originate in the nervous system at the electrical level.”
While the field is only about 15 years old, neuromodulation already has proven results in helping many kinds of patients. “One of the most common applications of neuromodulation is for providing relief for refractory movement disorders like Parkinson’s disease and dystonia,” says Kopell. “More recently, we’re finding tremendous benefit in using neuromodulation to treat chronic pain and psychiatric disorders that have proven resistant to previous treatments.”
Signs and symptoms:
Patients are considered potential candidates for neuromodulation only after traditional treatment approaches have failed.
“The only way to know if you might benefit from neuromodulation is to get evaluated,” says Kopell. “Typically, patients are referred for evaluation because their drug regimen either isn’t working well or it’s causing side effects that are intolerable.”
For instance, the dyskinesia, or tremors, associated with Parkinson’s disease are often a side effect of medication, not the disease itself.
While the field is only about 15 years old, neuromodulation already has proven results in helping many kinds of patients. “One of the most common applications of neuromodulation is for providing relief for refractory movement disorders like Parkinson’s disease and dystonia,” says Kopell. “More recently, we’re finding tremendous benefit in using neuromodulation to treat chronic pain and psychiatric disorders that have proven resistant to previous treatments.”
Signs and symptoms:
Patients are considered potential candidates for neuromodulation only after traditional treatment approaches have failed.
“The only way to know if you might benefit from neuromodulation is to get evaluated,” says Kopell. “Typically, patients are referred for evaluation because their drug regimen either isn’t working well or it’s causing side effects that are intolerable.”
For instance, the dyskinesia, or tremors, associated with Parkinson’s disease are often a side effect of medication, not the disease itself.
Evaluation for neuromodulation is noninvasive, and involves getting a few imaging scans, a physical exam and meeting with doctors. “The first step is always to identify the various nervous circuits that are responsible for the disease’s symptom,” says Kopell. “The problem area could be anywhere in the nervous system — in the brain or spinal cord, the peripheral nervous system or the autonomic nervous system.”
Traditional treatment:
The form a neuromodulation surgery takes depends on where the problem is located. “The common link is that neuromodulation always entails implanting a device in the faulty circuit to affect and improve its function,” says Kopell. “Depending on the patient, neuromodulation can be a brain surgery, spinal surgery or peripheral nerve surgery.”
One of the most common forms of neuromodulation surgery is for treating Parkinson’s disease. “For these patients, we place a deep brain stimulator in a target area in the brain that is connected to other areas in the brain,” says Kopell. “While using a stereotactic head frame to steady the head, we open up the skull, map the brain and use a tiny recording electrode to make sure that we place the permanent electrode in the right position.” Another common form of neuromodulation implants a drug delivery device in the spinal cord.Traditional treatment:
The form a neuromodulation surgery takes depends on where the problem is located. “The common link is that neuromodulation always entails implanting a device in the faulty circuit to affect and improve its function,” says Kopell. “Depending on the patient, neuromodulation can be a brain surgery, spinal surgery or peripheral nerve surgery.”
The neuromodulation device remains implanted for the rest of the patient’s life. “It’s like a pacemaker in the heart — you don’t take it out,” says Kopell. “Post-surgery, patients will see their doctor on a periodic basis for programming and refitting.”
While neuromodulation is a surgical procedure, it carries a low risk of complications. “The risk benefit profile is extremely kind,” says Kopell. “Neuromodulation can be transformative. I’ve seen children completely disabled by dystonia — basically, they’re human pretzels — go back to having a normal life.”
Research breakthroughs:
The whole field of neuromodulation is young, and one of the most exciting areas of growth is exploring new neurological disorders to treat. “Neuromodulation has a huge potential for treating psychiatric diseases like major depression or OCD because there’s so much unmet need,” says Kopell. “I’ve seen patients who were debilitated for decades by depression go back to a normal life after neuromodulation.”
Right now, there is still limited approval for the psychiatric applications of neuromodulation, which are mostly available through clinical trials.
Questions for your doctor:
If you are starting to experience side effects from drugs taken for a chronic pain, psychiatric or movement disorder, ask, “Is there an alternative to the medication?”
If an evaluation finds you are a candidate for neuromodulation, ask, “What are the risks and benefits?”
While not everyone is a candidate, neuromodulation provides tremendous results for some patients. “For thousands of patients, neuromodulation is life-changing,” says Kopell. “This is about as close to miracle surgery as you see in medicine — period.”
What you can do:Questions for your doctor:
If you are starting to experience side effects from drugs taken for a chronic pain, psychiatric or movement disorder, ask, “Is there an alternative to the medication?”
If an evaluation finds you are a candidate for neuromodulation, ask, “What are the risks and benefits?”
While not everyone is a candidate, neuromodulation provides tremendous results for some patients. “For thousands of patients, neuromodulation is life-changing,” says Kopell. “This is about as close to miracle surgery as you see in medicine — period.”
Get informed.
Be your own best advocate.
“If you feel like your doctor’s current approach to your neurological illness is not satisfactory, don’t be shy about asking if you’re a candidate for neuromodulation — and get a second opinion,” says Kopell.
See a specialist.
Kopell says centers with dedicated neuromodulation teams are the places where you want to receive care.
By the numbers:
It’s estimated that only 10%-15% of patients eligible for neuromodulation receive the therapy.
About 60,000 Americans are diagnosed with Parkinson’s every year.
Major depression is the No. 1 cause of disability in the world.
10% of patients with major depression do not respond to traditional treatment methods, which makes them potential candidates for neuromodulation.
Attorney Doug Stoehr works with clients who suffer from chronic pain as a result of an accident or injury. For more information on his central Pennsylvania law practice, please visit his website at http://www.stoehrlaw.comor call his office at 814-946-4100.
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