You might think of brain surgery as something only used for the most serious, life-threatening conditions, such as a malignant tumor or traumatic injury. But the future of brain surgery increasingly isn’t just about saving lives, it’s about finding ways to mitigate symptoms caused by chronic conditions such as depression, epilepsy and Parkinson’s disease. The top-ranked neurosurgery department at St. Luke’s Health is leading the way for broader uses of these innovative treatments, offering advanced procedures and pioneering clinical trials.

What Is Neuromodulation?

Neuromodulation is a therapeutic technique that changes nerve activity via electric stimulation from small devices implanted in the brain or spine. Much like how a pacemaker regulates the heart’s electrical activity, a neuromodulation device targets specific neural pathways to change nerve function. Neuromodulation can be noninvasive (transcranial magnetic stimulation), but it the most common procedure involves a small device implanted via neurosurgery. If the treatment does not work as the patient desires, neuromodulation implants can be removed. 

During some surgical neuromodulation procedures, a surgeon places tiny leads inside your skin near the nerve affecting your condition. Controlled by a generator the size of a watch face, these leads convey mild electric shocks to the nerve to change how it behaves. The pattern of this stimulation can be altered and turned on and off with a remote controller. 

Some neuromodulation procedures to relieve pain or spasticity involve implanting a tiny pump that dispenses small doses of specific medications to the local area. The surgery for this will be slightly different.

Why Neuromodulation Use Is Growing

Around a third of people worldwide suffer from neurological conditions such as dementia, epilepsy, migraine and neuropathy, which is nerve damage that can cause chronic pain. One in five adults in the U.S. experience mental illness such as depression, anxiety and obsessive-compulsive disorder (OCD). Many of these patients will be able to manage their illnesses with some combination of medication, lifestyle changes, physical therapy, talk therapy or other conservative treatments. But some patients have treatment-resistant illnesses that do not respond to standard therapies. Additionally, conditions such as Parkinson’s disease grow progressively worse over time.

Some neuromodulation procedures may help patients with certain treatment-resistant, chronic or progressive conditions. These surgeries can help improve quality of life, restore motion function or alleviate pain for the long term. Current uses of neuromodulation include:

• Deep brain stimulation (DBS) to reduce tremors caused by Parkinson’s disease

• DBS for epilepsy

• DBS to improve severe depression

• Intraspinal drug delivery (IDD) for back pain and spasms

• Sacral nerve stimulation to treat incontinence

• Spinal cord stimulation (SCS) to reduce back pain

Clinical Trials

Numerous clinical trials are underway or planned that will test new types of neuromodulation devices or try current FDA-approved devices for new conditions or to treat different aspects of certain conditions. SLH and Baylor College of Medicine are involved in several of these trials, including: 

• DBS use for depression

• Multiple trials to treat OCD

• SCS for chronic pain

• SCS to improve Parkinson’s symptoms

SLH has helped pioneer the use of DBS for treatment-resistant depression, and more clinical trials for psychiatric uses will be underway soon.

Hope Is Around the Corner

At SLH, our neurosurgeons spend extensive time with patients and their families to ensure they have a complete overview of the risks and benefits of neuromodulation procedures. These long appointments also contribute to longer waits to see a provider, but we feel they are crucial for the best outcomes, even if patients opt to not get surgery.

Fortunately, SLH is actively recruiting new neurosurgeons so we can expand our services and increase efficiency. We know it can be hard to be patient during that wait to see someone, but we are constantly striving to improve care so that people need not wait as long.