Deep Brain Stimulation (DBS)
What is deep brain stimulation?
Deep brain stimulation (DBS) uses electrical stimulation to treat neurological conditions
such as Parkinson disease (PD), tremors, and dystonia. DBS can help with movement
problems such as stiffness, trouble walking, and slowed movement. While it does not
cure these conditions, DBS can ease symptoms. It may also decrease the amount of medicine you
need. It may also help treat depression. Research is ongoing to find out how well
Movement-related symptoms of PD and other neurological conditions are caused by faulty
electrical signals in the parts of the brain that control movement. DBS does not damage
brain tissue. Instead, it blocks the faulty signals that cause tremors and other movement
DBS is done by placing an electrode inside the brain. The electrode is connected to
a very small neurostimulator (electrical generator) put in your chest or abdomen.
Electric current is sent from the neurostimulator to the electrode in the targeted
part of brain tissue causing the symptoms.
Why might I need DBS?
DBS may be an option for certain people with neurological problems when medicines don't
work as well or when side effects of the medicines interfere with daily activities.
One of the main uses of DBS is to treat symptoms of PD. It can help when medicines
don't work well anymore, or when movement problems or side effects worsen. DBS does
not stop PD from worsening with time though.
DBS may also be used to treat:
Essential tremor. This health problem causes a rhythmic trembling of the hands, head, voice, legs,
Intractable pain. This pain can’t be eased by usual medical or surgical treatment.
Dystonia. This is a movement disorder in which muscles contract involuntarily.
Epilepsy. This is a long-term (chronic) disease that causes seizures. The seizures can happen
without warning and can happen again and again.
Mental health (psychiatric) conditions, such as obsessive-compulsive disorder, anxiety
and depression. When these conditions don’t respond to medicine or other treatments.
Your healthcare provider may have other reasons to advise DBS.
Not all people with these health problems are good candidates for DBS. Talk with a
neurologist who specializes in movement disorders to see if DBS may be right for you.
What are the risks of DBS?
As with any procedure, complications can occur. They may include:
Reactions to anesthesia
Bleeding in the brain
Leaking of cerebrospinal fluid (the clear fluid around the brain and spinal cord)
Pain or swelling at the surgery site
Movement of the electrode from the original place
Allergic reaction to parts of the implanted device
Device wire becomes disconnected or does not work correctly
Side effects that may occur after the surgery include:
Temporary tingling in the face and limbs
Problems with speech or vision
Jolting or shocking sensation
Dizziness or loss of balance
Trouble with concentration
There may be other risks, depending on your specific health condition. Talk about
any concerns with your healthcare provider before the procedure.
How do I get ready for DBS?
DBS requires a commitment to participate in evaluations, procedures, and consultations
before and after the procedure. DBS is usually only available in large medical centers.
If you don't live close to a medical center that offers DBS, you may need to spend
a lot of time traveling. The procedure and appointments can be costly. It's also important
for you to have realistic expectations. Although DBS can improve symptoms, it will
not cure the condition.
Before DBS, you will have assessments to determine whether this is a good option for
you. You will need tests to check memory and thinking. You may see a psychiatrist
to determine if you have a condition such as depression or anxiety that needs to be
treated before DBS.
Ask your healthcare provider about what you might need to do in the days and weeks
before DBS, such as changing your diet or stopping certain medicines.
What happens during DBS?
Implanting a DBS lead generally requires a hospital stay of a day or longer. Procedures
may vary based on your condition and your healthcare provider’s practices. The lead
and neurostimulator may be put in at the same time. Or the neurostimulator may be
placed in a separate procedure after the lead is put in. Talk with your healthcare
provider about what to expect.
Generally, surgery for DBS goes like this:
Implantation of lead
Numbing medicine will be injected into your scalp. A head frame will be placed to
keep your head in the right position for the procedure. A computed tomography (CT)
scan or magnetic resonance imaging (MRI) scan will be taken to find the target site
in the brain for the electrode.
You will be awake during the surgery. You will be asked to move certain parts of your
body as the lead is being placed.
After more numbing medicine is injected into your scalp, the neurosurgeon will drill
a small hole in the skull to insert the lead.
Recordings will be taken as the lead is moved through the brain tissue. This helps
pinpoint the exact place for the lead. You may be asked to move your face, arm, or
leg at certain times while the recordings are being taken.
Once the precise location for the lead has been found, it will be attached to an external
neurostimulator. Electrical stimulation will be given through the lead for a short
time to see if symptoms improve. Your surgeon may cause side effects on purpose with
electrical stimulation to make sure the lead is in the right place.
The lead will be attached after it's in the right place. A wire to connect the lead
to an extension to the neurostimulator will be placed under the scalp.
The hole in the skull will be closed with a plastic cap and stitches.
Placement of the neurostimulator
This may or may not be done at the same time the electrode is placed.
You will receive general anesthesia so that you are asleep during the procedure.
The neurostimulator will be inserted into a “pocket” under the outer layers of skin
tissue. This is often just under the collarbone, or in the chest or abdomen.
An extension wire will be attached to the neurostimulator and to the brain lead.
After the neurostimulator is implanted, it's programmed to send an electrical signal.
Programming is often done a few weeks after the neurostimulator is put in.
Programming the neurostimulator
Programming the neurostimulator is a process that occurs over time. You will likely
go back several times for adjustments to the settings. Your medicines may also be
adjusted. The goal is control your symptoms with the most appropriate amount of electrical
stimulation and medicine.
Once your “best” settings have been determined, you will need to go back from time
to time for checkups. Your healthcare provider will plan your follow-up schedule based
on your particular situation.
You will be given a magnet to turn the neurostimulator on or off under conditions
prescribed by your healthcare provider.
The neurostimulator is about the size of a stopwatch. It's powered by a long-lasting
battery that generally lasts 3 to 5 years. When the battery starts to wear out, the
neurostimulator will be replaced with a new one in an outpatient procedure.
What happens after DBS?
In the hospital
You will be watched for complications, such as seizures. In general, the hospital
stay after a DBS procedure is 24 hours. But you may stay longer if problems develop.
Before you are discharged from the hospital, arrangements will be made for a follow-up
visit with your healthcare provider. They will also give you instructions for home
Once you are home, it’s important to keep the incisions clean and dry. Your healthcare
provider will give you specific bathing instructions. If stitches were used, they
will be removed during a follow-up office visit. If adhesive strips are used, they
should be kept dry. They generally will fall off within a few days.
Living with a DBS neurostimulator
Consider these precautions. Talk about them with your healthcare provider:
Always carry an ID card that states you have a DBS neurostimulator. You may also want
to wear a medical ID bracelet.
Let airport security screeners know you have a neurostimulator before going through
the airport detectors. In general, airport detectors are safe. But the small amount
of metal in the neurostimulator may set off the alarm. If you are chosen for more
screening by hand-held detector devices, politely tell the screener that the detector
wand should not be held over your neurostimulator for longer than a few seconds. These
devices contain magnets. They may affect the function or programming of your neurostimulator.
You may want to bring a note from your healthcare provider about your implanted device.
You may not have certain MRI procedures. That's because these machines use large magnets
You should stay away from places with large magnetic fields, such as power generators
and automobile junkyards that use large magnets.
Don't use heat in physical therapy to treat muscles.
Stay away from high-voltage or radar machinery, such as radio or TV transmitters,
electric arc welders, high-tension wires, radar installations, or smelting furnaces.
If you are scheduled for a surgery, tell your surgeon that you have a neurostimulator long
before the operation. Also ask your healthcare provider’s advice on whether anything
special should be done before and during the surgery. The electrocautery device that
controls bleeding may interfere with the neurostimulator.
When doing physical, recreational, or sporting activities, protect yourself from harming
the neurostimulator. A blow to the chest near the neurostimulator can affect how it
works. If you are hit in that area, you should contact your healthcare provider right
away to have it checked.
Long-term effects of DBS
DBS can help improve symptoms of tremors, stiffness, slowness, and movement problems.
It can also help with medicine therapy by decreasing the dose needed. Decreasing the
dose of medicine can ease side effects of long-term medicine use. Many people see
their symptoms improve for several years after the procedure. They are able to do basic
activities, such as eating, toileting, and dressing. Memory, thinking, and mood may
or may not be affected. Many neurological conditions are progressive. So later problems
can develop. If they do, the gains gotten from DBS may eventually be lost.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure