Deep Brain Stimulation (DBS)
What is deep brain stimulation (DBS)?
Deep brain stimulation is a treatment for movement difficulties, such as muscle tremors, muscle stiffness, and slowed movement. Deep brain stimulation treats movement difficulties caused by neurological conditions, such as Parkinson’s disease, essential tremor, and dystonia.
Movement difficulties occur when the brain sends out faulty electrical signals to the muscles. Deep brain stimulation uses electrical impulses to block faulty signals and improve movement problems.
Your brain functions like an electrical circuit board. Different areas of the brain control different activities and functions, such as emotions, thoughts, sensations, and muscle movement. All activities and functions are the result of electrical signals that pass through cells called neurons. Malfunction of these electrical signals can make your muscles contract too quickly, too slowly, or not at all. Deep brain stimulation stops faulty electrical signals from passing through neurons.
Deep brain stimulation is only one method used to treat movement problems and disorders. Discuss all of your treatment options with your doctor to understand which options are right for you.
Types of deep brain stimulation devices
Deep brain stimulation involves surgical placement of three devices into your body. The devices include:
Lead (electrode), a wire with an electrode that is placed in the specific area of your brain that is sending faulty signals to your muscles
Neurostimulator (internal pulse generator, or IPG), a small battery-operated computer designed to send electrical impulses to your lead
Extension, an insulated wire that connects the lead to the neurostimulator
All deep brain stimulation devices are removable if they cause allergic reactions, if they are not effective, or if better treatments are developed for your condition.
Why is deep brain stimulation (DBS) performed?
Your doctor may recommend deep brain stimulation to treat movement problems. Problems include involuntary muscle contractions, stiffness, difficulty walking, and tremors caused by certain neurological conditions. These conditions include:
Parkinson’s disease, a degenerative brain disorder that leads to uncontrollable shaking, muscle stiffness, and severe problems with coordination and balance
Essential tremor, a neurological condition that causes trembling back-and-forth movements of the hands, head, arms, legs, torso and voice
Dystonia, a movement disorder that causes involuntary muscle spasms and contractions throughout the body leading to movements such as contorting, pulling and twisting
Your doctor may only consider deep brain stimulation for you if other treatment options with less risk of complications, such as medications, have failed to prevent or lessen movement problems. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on deep brain stimulation.
How is deep brain stimulation (DBS) performed?
Your deep brain stimulator device surgery takes place in a hospital. The surgery takes several hours. Your surgeon may implant the lead and the neurostimulator in two separate surgeries. The surgery generally includes these steps:
You will dress in a patient gown and remove any jewelry, wigs, glasses, dentures, and any other items that may interfere with the surgery.
Your care team will start an intravenous (IV) line. You will receive fluids and a mild sedative and possibly other medications through your IV. You will remain awake for the first part of the procedure, when your surgeon inserts the lead into your brain.
Your surgeon will make four small injections of local anesthetic in your head to numb the area. Your care team will attach a head frame to your head with pins at the site of the anesthetic injections. The frame holds your head in the correct position for the procedure. Your care team will not need to shave your hair to fit your frame.
The care team will take brain-imaging scans (pictures) to locate the area of your brain where your surgeon will place the lead. The scan might be an MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan.
Your surgeon will inject additional anesthetic medication into your scalp, drill a small hole in your skull, and insert your lead.
Your surgeon will ask you to make certain movements, such as moving your face or hands, to help determine the best lead positioning.
Your surgeon will verify accurate placement of the lead by attaching it to a temporary, external neurostimulator. The neurostimulator sends electrical stimulation to your lead to test its placement.
Your surgeon will attach the lead to an extension wire that will connect it to your permanent, internal neurostimulator. The extension wire runs under the skin of the head, neck, and shoulder to the chest or belly. Your surgeon will close the hole in your scalp.
Your surgical team will give you general anesthesia to put you into a deep sleep and your surgeon will implant your neurostimulator in your chest or belly. Your neurosurgeon will attach the neurostimulator to the lead wire and close the incision. This step may be done immediately after placing the lead in the brain or is a separate surgery about a week later.
Your neurosurgeon will turn on and adjust your neurostimulator. This may occur the same day as your surgery or a week or two later. It may take a few weeks and several adjustments before your neurostimulator is adjusted precisely to relieve your symptoms.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel a pinch or prick when the IV is inserted and stinging when the local anesthetic is injected. Some people report a feeling of pressure when they are fitted with a head frame, but this feeling usually goes away within a few moments.
You will have enough sedative medications so that you stay comfortable. Tell your doctor if you are uncomfortable in any way.
What are the risks and potential complications of deep brain stimulation (DBS)?
As with all surgeries, deep brain stimulation implantation involves risks and possible complications. It is generally considered safe for appropriately selected patients, but complications may become serious and life threatening in some cases. Complications of the deep brain stimulation may occur during or after surgery to implant the devices, or months or years later.
Complications of deep brain stimulation include:
Adverse reaction to sedation, anesthesia, or medications, which can include an allergic reaction and problems with breathing
Bleeding in the brain, which can be mild or serious and cause paralysis; stroke; changes in thinking, memory, and personality; and other neurological problems
Breakage of your devices through trauma or wear and tear
Leakage of cerebral spinal fluid, which can result in infection (meningitis)
Neurological side effects, which can include dizziness, minor paralysis, tingling, a shocking sensation, and problems with speech, vision, coordination and balance. These are generally temporary or mild.
Neurostimulator or lead malfunction, which requires reprogramming or replacing
Shifting of implanted devices, which includes movement of the lead from its proper position, detachment of the wire connecting the lead to the neurostimulator, or emergence of the wire or neurostimulator through the skin
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Avoiding close or prolonged exposure to electrical devices or devices that have a strong magnetic field. Your doctor will give you specific instructions about these devices.
Following activity, dietary and lifestyle restrictions and recommendations before surgery, during your recovery, and as long as you have deep brain stimulation
Notifying your doctor immediately of any concerns including dizziness, minor paralysis, tingling, a shocking sensation, and problems with speech, vision, coordination and balance
Taking your medications exactly as directed. Some medications reduce the risk of unnecessary electrical impulses.
Telling all members of your care team if you have any allergies
How do I prepare for my deep brain stimulation (DBS)?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a deep brain stimulation device implantation by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Following any instructions exactly about eating and drinking before your deep brain stimulation device implantation procedure
Getting preoperative testing and assessments as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include the Unified Parkinson Disease Rating Scale assessment, blood tests, imaging tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before deep brain stimulation surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need deep brain stimulation? Are there any other options for treating my condition?
Which type of devices will I need? How many leads will I need?
Will you implant the lead and the neurostimulator during the same surgery?
How long will the surgery take? When can I go home?
What short- and long-term restrictions will I have after the surgery?
When can I return to work and other activities?
What electrical devices should I avoid after the devices are implanted? What medical testing should I avoid?
What kind of assistance will I need at home?
How should I take my medications?
What testing and assessments will I need before and after the surgery?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my deep brain stimulation (DBS) device implantation?
Knowing what to expect can help make your road to recovery after deep brain stimulation device implantation as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery you are alert, breathing effectively, and your vital signs are stable. A hospital stay of one to two days is usually required. This allows your care team to monitor your recovery and make sure that your implanted devices are working properly. You will be discharged home with specific instructions about when to follow up and the care of your incisions and devices.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, your general health, your age, and other factors. Your doctor may ask you to avoid strenuous activities or heavy lifting for about a month after surgery. Most people return to light to moderate activities within a few weeks.
How will I feel after the deep brain stimulation device implantation?
You may have pain, swelling and tenderness at the device placement sites for several days after the surgery. Over-the-counter and prescription pain medicines can reduce discomfort. Ask your doctor before taking any pain medication and only take pain medication as directed. Call your doctor if your pain is not well controlled by your medication.
When will deep brain stimulation treatment begin?
Your deep brain stimulation treatment begins when your doctor activates your neurostimulator. This sends electrical signals to your lead. Your doctor may do this before you leave the hospital or a few weeks after the implantation surgery.
Your doctor will need to see you for several appointments over the following weeks and months. Your doctor will make adjustments to ensure that your neurostimulator is treating your muscle movement problems effectively.
When should I call my doctor?
It is important to keep your follow-up appointments after deep brain stimulation device implantation. Contact your doctor for questions and concerns between appointments.
Call your doctor right away or seek immediate medical care if you have:
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Unexpected drainage, pus, bleeding, redness or swelling of your incisions
How might deep brain stimulation affect my everyday life?
Deep brain stimulation will not cure the underlying disease causing your movement problems, but it can significantly improve symptoms, such as tremors, walking problems, and rigidity. It can also decrease your need for some medications, which reduces side effects.
Your implanted devices will require special care and lifestyle changes that include:
Alerting all of your healthcare providers, including your doctors, surgeons, physical therapists, and dentists, that you receive deep brain stimulation. You may need to avoid some medical and dental procedures, such as magnetic resonance imaging (MRI). You should carry an ID card or wear an ID bracelet that identifies your implanted devices.
Alerting airport security that you have deep brain stimulation devices implanted. The devices may set off security alarms and may be damaged by security wands
Avoiding close or prolonged exposure to certain electrical devices or devices that have a strong magnetic field. Your doctor will provide specific instructions on which devices to avoid.
Avoiding contact sports and activities that could loosen or damage your implanted devices
Following up regularly with your doctor. Your doctor will need to check your implants on a regular basis. Your doctor will assess if the battery or wires need to be replaced and if other devices have affected the signaling. Your doctor will also check progression of your disease and reprogram your neurostimulator as needed.
Needing more surgery or procedures in the future. This may include replacement of the lead, neurostimulator, neurostimulator batteries, or the extension wire. The neurostimulator batteries generally last three to five years.