Deep Brain Stimulation

 

Deep brain stimulation (DBS) is a surgical treatment for patients with advanced movement disorders including Parkinson’s disease, essential tremor, and dystonia.  The therapy features the implantation of tiny wires into the brain.  These wires help deliver continuous electrical impulses, or stimulations, to areas deep in the brain. These electrical impulses originate from a neurostimulator, which is a medical device similar to a pacemaker that is implanted under the collarbone.

When is DBS offered? 

Typically, DBS is often considered in patients with Parkinson’s disease, essential tremor or dystonia when motor symptoms are not being well controlled by medications or the side effects from the medications are not well tolerated. 

Preparation for DBS:

Patients who, with their primary doctor, feel that they may benefit from DBS will be scheduled to see members of the comprehensive DBS team. These evaluations help understand your motor and cognitive function with and without medication. A general health screening may also be recommended. Your case will be presented before a conference of experts to determine if DBS could be helpful to you. Once it is determined that DBS is the best option you will be called by a team member to offer you the surgery and schedule a visit with the neurosurgeon who performs the procedures. This neurosurgeon will discuss the surgery with you in detail.   

Patients, doctors and family members or care givers need to carefully review and discuss the risks and benefits of DBS to determine if this is the appropriate treatment for the patient at this time.We also offer DBS support groups you can attend to directly interact with patients who have undergone the procedure previously.

The surgery: 

Patients have a lightweight customized platform attached to the head to insert the electrodes. (This is created based on previously acquired MRI and CT images that are used to map the patient’s brain and identify where the wires should be implanted.) 

Often, patients are awake during this surgery to improve the precision and effectiveness of procedure. In these cases, sedation and local anesthetic are given to maintain patient comfort throughout the procedure.  Asleep procedures with intraoperative imaging are available for patients who feel unable to tolerate the procedure awake. 

The surgeon will then implant the electrodes through small incision and drill holes into the brain. While implanting the wires in a patient that is awake, the surgeon will test symptom improvement and side-effects to help ensure the 

placement is correct. Implantation of the “pacemaker” battery will follow at a later time under a general anesthesia.

Surgical risks:

DBS is generally a safe and well established surgery, but like all brain surgery, it does have small attendant risks. Thus, there are rare risks such as hemorrhage, infection, neuropsyciatric effects, seizure and others that may occur.  As with all surgeries there is some temporary swelling and discomfort that occurs at the implantation site. Mortality from this procedure is very low at 0.4%.  

How does the stimulator work?

Individuals with PD, essential tremor or dystonia have neurons networks that are behaving in abnormal electrical firing patterns. These abnormal patterns of firing create the motor symptoms experienced by patients. The stimulation helps to regulate and restore normal signal patterns that, in turn, improve movement and reduce active symptoms of tremor. 

The Programming:

After the surgery, you will be scheduled for programming visits in the movement disorders clinic, typically occurring at 4, 8, and 12 weeks following surgery. During those visits, a series of stimulations will be tested to determine optimal benefits from DBS. We will work with you and your individual situation to achieve best treatment outcomes and control your symptoms. As you experience benefit from DBS stimulation, we are often able to reduce your medications you are required to take. You will also receive a patient programmer so you can turn stimulation off if needed, e.g. when undergoing a surgical procedure in the future.