Specialties

  • Deep Brain Stimulation

  • What is Deep Brain Stimulation?

    Deep brain stimulation (DBS) therapy is used to treat disabling neurological symptoms, most commonly found in Parkinson’s disease, such as tremor, rigidity, slowed movement, and gait problems. This therapy can also be used in patients suffering from essential tremor, dystonia, and obsessive-compulsive disorder (OCD).

    DBS involves surgically implanting a lead (also called an electrode) in the patient’s brain. The lead is then connected to a pulse generator (battery pack) implanted under the skin near the collarbone. Impulses from the pulse generator interfere with and block the electrical signals that trigger motion disorders.

    What are the benefits of DBS?

    While DBS treats many aspects of Parkinson’s disease, the primary benefits are reduced tremor and rigidity, reduced medication dosage and improved facial expression and voluntary movement. DBS has been used in more than 100,000 patients over the last
    two decades and has been proven to be more effective than treatment with medication alone. Furthermore, recent studies have shown that DBS can prolong life. Deep Brain Stimulation is possibly the single most effective treatment for idiopathic Parkinson’s disease.

    Most patients see immediate benefits from DBS. While DBS is not a cure, the benefits are in the quality and quantity of life it affords patients. DBS allows patients to return to normal activities or to work and helps patients maintain their independence.

    What happens during DBS surgery?

    The 3 stages of DBS Implantation

    DBS surgery typically takes place over three(3) separate stages over the course of approximately five(5) weeks.

    Stage #1
    A minor outpatient procedure is performed to implant bone fiducials that imaging markers are attached to. Following the procedure a CT scan will be taken for your physician to use in accurately placing electrodes. This procedure is approximately one week prior to Stage 2.

    Stage #2
    This is an in-patient surgical procedure where simulation testing will be performed followed by the permanent placement of the electrode in the brain. Patients are awake for this procedure allowing the neurosurgeon to monitor the brains electrical activity and to perform tests which ensure that the electrodes are optimally placed in the brain. A one to two night hospital stay is required.

    Stage #3
    An outpatient procedure is performed to implant the internal pulse generator (IPG) and to connect the DBS electrodes. This may take place approximately two weeks following Stage 2.

    Each patients plan of care is customized in consultation with the neurosurgeon.

    What happens after DBS surgery?

    Unlike other surgeries, implantation of the deep brain stimulator is just the start of your treatment. Patients who have undergone DBS therapy will need to seek continuous follow up medical care from their primary care physician and/or neurologist. Careful programming of the deep brain stimulator is fundamental in achieving optimal outcomes. This requires several visits to the neurologist who will program the deep brain stimulator and make adjustments in medications. Some DBS patients will qualify for admission to an inpatient rehab unit where patients can rehabilitate under the care of a neurologist and highly trained therapists. While in rehabilitation, the patient will be able to test the deep brain stimulator in real-world situations, allowing the device to be adjusted to their exact needs. Patients undergoing such intensive rehabilitation can see results sooner than those who do not go through this treatment.

    Patients who have undergone DBS therapy could also consider outpatient rehabilitative services including the LSVT LOUD™ and LSVT BIG™ Programs (Lee Silverman Voice Treatment) for people with neurologic disorders. These are researched based programs wherein speech, physical, and occupational therapists work with patients to improve voice quality and projection as well as balance and motor control.


    Mariel Szapiel, MD - Neurological Surgeon
    Mariel Szapiel, MD

    Neurological Surgeon

    Mariel Szapiel, MD, joined Neurosurgical and Spine Specialists in August of 2014. As the single Fellowship trained Stereotactic and Functional neurosurgeon in the South Denver/Parker/Castle Rock Area, we are very excited to welcome her into our practice. Interested in the sciences since a young age, Dr. Szapiel received her Bachelor’s degree in Industrial Microbiology from the University of Puerto Rico in 1999, where she graduated Magna Cum Laude. She then moved on to complete her medical degree from the University Of Puerto Rico School Of Medicine, in San Juan, also graduating Magna Cum Laude in 2003.

    While in medical school, Dr. Szapiel was also accepted into the prestigious honor medical society Alpha Omega Alpha. When she finished her residency training at The Ohio State University Medical Center in 2010, Dr. Szapiel became one of only two female graduates from her medical school to ever complete a residency in Neurological Surgery in the United States.

    After residency, she remained at The Ohio State University in Columbus, Ohio for an additional year to complete her Fellowship training in Stereotactic and Functional Neurosurgery. As part of her fellowship, she had the unique opportunity to be involved in cutting edge research into Deep Brain Stimulation (brain pacemakers) for movement disorders as well as other neurological conditions such as severe disability from stroke, traumatic brain injury, psychiatric disorders and obesity. As part of her fellowship, Dr. Szapiel also obtained extensive experience with other neuromodulation techniques (spinal cord stimulation, occipital nerve stimulation) for pain.

    Dr. Szapiel also practices general neurosurgery. Her other clinical interests include neuro-oncology, epilepsy, and spine disorders/surgery. She is a member of the American Association of Neurological Surgeons (AANS), the congress of Neurological Surgeons (CNS), the American Society for Stereotactic and Functional Neurosurgery (ASSFN) and the North American Neuromodulation Society (NANS). Dr. Szapiel is currently Board Eligible. Dr. Szapiel is fluent in English and Spanish.

    Dr. Szapiel specializes in:

    • Deep Brain Stimulation (DBS) for movement disorders
    • Spinal cord stimulation for pain
    • Occipital nerve stimulation for occipital neuralgia and other chronic headache disorders
    • Epilepsy Surgery including Vagal nerve stimulation
    • Neuro-oncology
    • Spinal disorders and Surgery
    • Fellowship trained in Stereotactic and Functional Neurosurgery


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