We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
We will guide you from your first visit to the centre, allowing you to find all the departments and make the most of our facilities. Whatever the reason for your visit, we will explain how to get about the hospital.
Deep brain stimulation (DBS) is an effective treatment for people with a movement disorder, such as dystonia, Parkinson's, myoclonic movements, tremors, or tics. At Vall d'Hebron University Hospital we use this treatment in children and adolescents with forms of dystonia and other movement disorders.
The treatment consists of placing electrodes in the globus pallidus nuclei of the brain, which will perform a pacemaker function to modulate the abnormal 'beat' of the neurones. The goal of this neurosurgery is to reduce undesirable muscle spasms (forms of dystonia, myoclonic movements, tremors) and improve voluntary motor activity during manipulation, walking, and coordination of movements in general, so that the patient's quality of life improves.
The system is implanted under the skin and is not visible to others. The only visible scar is on the skin of the abdomen, where the battery is implanted.
The team that performs this intervention at Vall d'Hebron Hospital is made up of experts in paediatrics and neurofunctional surgery in our centre and the Germans Trias i Pujol Hospital.
The device is made up of three components:
It is important to use the device well and to charge the battery periodically. Otherwise, if the stimulator were left without power, the system would shut off and the symptoms that had improved with electrical stimulation would reappear.
At Vall d'Hebron University Hospital, deep brain stimulation (DBS) is performed in infants and adolescents when medication has not yielded good results, and once the professionals decide that the risk-benefit relationship is favourable for the specific patient, individually.
The intervention is carried out in children over 6 years of age who suffer from moderate or severe intensity movement disorders with a negative impact on quality of life, and who do not present other associated severe neurological problems.
In order to carry out the intervention, before the surgery a magnetic resonance scan of the patient is taken. Then, on the day of surgical intervention, the neurosurgery team plans the coordinates for the electrodes in the brain nucleus that is intended to be stimulated, using the patient's brain MRI images and neuro-navigation software. At the same time, with the patient anaesthetised in the operating theatre, a stereotaxic frame is placed on the head.
A computed tomography (CT) scan is then performed on the patient and the images of the MRI and CT are merged to obtain the coordinates to place the electrodes.
Through two frontal incisions, the electrodes are placed in the brain nucleus to be stimulated, and the extension connecting the electrodes to the neurostimulator (battery) are placed under the skin behind the ear to the abdomen.
Once the system is implanted, a new CT is performed to check electrode localization and rule out complications.
The intervention is carried out by a team of professionals led by a neurosurgeon specializing in stereotaxic surgery. It is considered a 'minimally invasive' operation with very low risks. The possible difficulties are as follows:
On the third day after surgery, the neurostimulator is activated and stimulation parameters programmed. The beneficial effects of electrical stimulation take weeks to appear. Normally the full benefits are obtained around 12 months after the intervention.
When neurostimulation is effective, infants regain mobility, improve manipulation and autonomy in their day-to-day life, can write and paint, eat independently, walk, and run again. Usually, it is possible to reduce or withdraw the medication that the patient took to control the undesirable movements before the intervention. However, cerebral neurostimulation is compatible with other medical treatments.
It is important to understand that this therapy improves symptoms, but does not cure the disease that produces them. It also does not improve the mental health problems that the patient may have, although when stimulation is very effective and improves motor symptoms and pain, it can produce very positive changes in the quality of life of the patient.
In their day-to-day existence, once stimulation is adjusted, the patient has a normal life. They can participate in sports activities and have a great deal of autonomy. Of course, this treatment does require medical monitoring, and the patient must come in for a check-up at least once a year.
The patient will have no strange feelings caused by stimulation, but when changes are made during medical visits they may experience a mild and transient sensation of tingling or muscle tension.
This is an effective treatment for years, although some parameters may need to be adjusted if the disease worsens.
In cases where no improvement occurs, it is possible to turn off the neurostimulator without any further surgery. Neurostimulation is a reversible procedure, and once stimulation is turned off, the patient returns to their pre-intervention medical condition.
Children and adolescents carry a rechargeable neurostimulation system. Patients need to charge the battery once a week, for about 1 or 2 hours. It is a very simple system that children can do without the need for help. The system is charged by telemetry, by direct contact with the region of the abdomen where the battery is implanted, without plugging any power cables in.
The device has a half-life of approximately 20 years. After that, it would be necessary to change the implanted battery via local surgery.
To facilitate communication with other people regarding the precautions that must be followed, the patient is given a card explaining about the stimulation device implanted, where surgery was performed and who the reference doctors are.
During their day to day existence patients must take care to avoid exposing the system to electromagnetic fields that may interfere with the stimulation apparatus.
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