Deep Brain Stimulation

Overview

Deep brain stimulation (DBS) is a treatment for a variety of diseases, including Parkinson's disease, essential tremor, dystonia and obsessive compulsive disorder.

DBS works by changing electrical activity in the brain in a controlled manner. A DBS system has three components:

  • Small wires, called leads or electrodes, are placed in a targeted area in the brain.
  • An insulated wire, called an extension, is passed under the skin of the head, neck and shoulder to connect the lead to the neurostimulator or battery pack.
  • The neurostimulator — also called a pulse generator, battery pack or brain pacemaker — delivers precise doses of electricity to stimulate the brain. It is usually implanted under the skin near the collarbone.


Who is a candidate for DBS?

Patients being considered for DBS will have an evaluation to be certain that it will be a safe and effective treatment. You may be an ideal candidate for DBS if:

  • Medications have not been able to control your symptoms.
  • You are cognitively healthy. Those with dementia or significant memory problems are not good candidates for DBS. Surgery can make these conditions worse. Neuropsychological testing is used to help determine if someone is a candidate for DBS.
  • You do not have a serious heart or lung problem or other chronic illness that makes surgery too risky.


Placing the DBS system

Your neurosurgery care team will help you prepare for your surgery, hospitalization and recovery. They will tell you where to go and what specifically to expect during the procedures.

During the preparation phase:

  • Bring all medications and their exact dosages to your pre-operative appointment. You should also bring any vitamins, minerals or other supplements you take.
  • Discuss with your neurosurgeon whether you should stop taking medicine that might thin your blood, and, if so, when. This includes aspirin, Plavix, indomethacin, Coumadin and many herbal supplements.
  • Be sure to follow all instructions from your care team the night before your surgery. You will not be able to eat or drink anything starting at midnight before your surgery. Also, you will have to stop certain medications.

First procedure

The wires, or leads, are placed during the first surgery. You will be fitted with a frame that allows the surgeon to precisely place the DBS leads. You will have an imaging scan to make sure the frame is fitted properly. These scans also guide your surgeon in placing the leads.

During the surgery, some patients are asleep and others are kept awake so the placement of the leads may be fine-tuned.

Patients typically go home the next day.

Your neurosurgeon and neurologist may decide that two wires (one on each side) are better for your case. If so, you will return the following week for another surgery for placement of the second wire, or lead.

Second procedure

The second procedure places the neurostimulator, or battery pack. Typically, it is performed three to five days after the initial surgery to place the leads. You will be given an anesthetic so you will sleep through the procedure. The battery pack is placed just below the collarbone and attached to the leads with a wire that runs under the skin.

This procedure is usually performed on an outpatient basis, and you will go home the same day.

Starting DBS treatment

Treatment using DBS usually begins about three to four weeks after the system is surgically implanted and can last from one to two hours.

  • Your programming neurologist will check the battery pack to make sure it and the contacts in the lead wires are working correctly. They will program the device through multiple settings to determine which settings will work the best for you. You may have to take your medications during this visit to see the effect of stimulation and medication together.
  • Your medication may be adjusted, and you may take lower doses than you did previously.
  • You may have follow-up visits as frequently as every two to four weeks until the right setting is found. As your symptoms stabilize, your visits will take place every few months.

This information is provided for patient use and is intended only as a general overview for this procedure. Any questions or concerns should be discussed directly with your physician.