Chronic pain or a movement-related disorder is a life-disrupting condition. While various therapies help manage pain and restore function, some patients struggle with symptoms despite treatment. Functional neurosurgery is a growing area of medicine that offers hope to some patients with chronic neurologic conditions.

What is functional neurosurgery?

Functional neurosurgery involves procedures and devices that aim to regulate neurologic function. Treatments include those that use electrical stimulation of the brain or spine to control abnormal brain impulses or interrupt pain signals.

Summit Health’s Neurosurgery department offers functional neurosurgery among its services. “These options are for patients who have exhausted all medical management of their respective diseases,” says Bailey Zampella, DO, who practices general neurosurgery and spine surgery and specializes in functional restorative neurosurgery.  

Types of treatment

Summit Health offers the following functional neurosurgical modalities:

• Deep brain stimulation (DBS) involves implanting electrodes into specific areas of the brain. The implant delivers electric impulses to modify the abnormal brain activity causing symptoms. DBS is used to treat movement and neurologic disorders, including:
  • Dystonia
  • Epilepsy
  • Essential tremor
  • Parkinson’s disease
  • Obsessive-compulsive disorder

In general, DBS may be an option for patients whose medications are no longer effective in maintaining a good quality of life. At Summit Health, a neurologist trained in movement disorders would evaluate a patient to determine whether DBS would be appropriate. The patient also would undergo neurocognitive testing.

Depending on a patient’s pathology, the neurologist and neurosurgeon may determine that focused ultrasound is a more appropriate treatment. Focused ultrasound is a noninvasive procedure that uses MRI and high-frequency energy to target abnormal brain activity.

If DBS is appropriate, the procedure happens in two stages. First, the neurosurgeon will implant the electrodes (at the end of a thin wire called a lead) in the brain through a small hole in the skull, positioning them in areas identified as those causing symptoms.

About two weeks later, the neurosurgeon will perform a second surgery to implant a battery-powered pulse generator under the skin below the collarbone. The pulse generator connects to the previously implanted lead, and a handheld device controls the generator to send electric pulses to the brain.

• Spinal cord stimulation (SCS) uses an implant in the spine to interrupt pain signals and help manage chronic pain. “Spinal cord stimulators are options for patients who are not optimal surgical candidates or who have exhausted all surgical measures and continue to have pain,” says Dr. Zampella.

Like deep brain stimulation, SCS treatment happens in two stages. First, a Summit Health pain management physician evaluates a patient and oversees a stimulator trial. The trial involves implanting an electrode in the patient’s spine and providing an external device (generator) to control the electrode. The patient will then test how well the stimulator reduces pain.

If the stimulator trial is considered successful, the Neurosurgery team will implant a permanent spinal cord stimulator. This time, the generator is inserted under the skin at the waist and connected to the electrode.

Follow-up care

After deep brain stimulation and spinal cord stimulation surgeries, patient care involves a team approach. Summit Health’s Neurosurgery team collaborates with Neurology, Physical Therapy, and Speech Therapy providers for stimulator management and additional care as needed. “We are an all-inclusive practice for our patients,” Dr. Zampella says.

Advancing care to improve quality of life

The field of functional neurosurgery is fast-growing and expanding its findings to help patients with movement disorders and chronic pain, Dr. Zampella says. “We are constantly finding new areas of the brain to implant stimulators to control a variety of disease processes,” she says, as well as offering nonsurgical options when needed.

In the meantime, Dr. Zampella is encouraged by patients for whom functional neurosurgery treatment has been effective. “I remember one patient who was unable to live a functional life secondary to his tremor,” she says, recalling his struggle to do things many of us take for granted, such as eating and getting dressed. “After he was implanted with a deep brain stimulator,” she continues, “he was able to regain control of his life.”

For Dr. Zampella, patient stories like these reinforce why she pursued her specialty. “Being a functional neurosurgeon allows me to help these individuals return to a functional life again,” she says.