What Is Deep Brain Stimulation?
You might be reading this because you have one of the following conditions:
- Parkinson's
- Drug-resistant epilepsy
- Essential tremor
- Dystonia
- Treatment-resistant obsessive-compulsive disorder (OCD)
While not a cure for any disease, deep brain stimulation (DBS) can help control your symptoms for better physical and mental wellbeing.
Who Is a Good Candidate for Deep Brain Stimulation?
You may be a candidate for DBS if your meet the following criteria:
- You have troubling "off" periods when your Parkinson's medication wears off before the next dose can be taken.
- Your medications aren’t effectively managing your symptoms for essential tremor, epilepsy, or OCD.
- You are in good physical health.
If you’re considering DBS, it’s also important to have realistic expectations. The surgery requires frequent monitoring and neurology visits (at least initially). Patients should not expect a cure, but rather an improvement in symptoms or symptom control. Other key factors include good physical health, a solid support system, and realistic expectations for treatment outcomes.
"I'm only 66 years old, and I have a husband, four kids, and 13 grandchildren to enjoy. I have been given my life back, I just can't tell you. There's no way to thank my health care team for all that they've done for me."
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Deep Brain Stimulation Surgery
Deep brain stimulation surgery involves three components:
- A pacemaker-like device called a pulse generator
- Thin wires called leads or electrodes that enter the brain
- Wires called “lead extenders” that connect the electrodes in the brain to the pulse generator in the chest
Your neurosurgeon will implant all three components inside your body. They will also use MRI technology to identify exactly which part or parts of your brain are causing your symptoms. This is where the electrodes will be targeted. You will most likely receive general anesthesia, which means you’ll be asleep throughout DBS surgery.
In the past, patients stayed awake during the procedure (which is possible because the brain has no pain receptors), but many were understandably too nervous to explain how the electrodes affected their speech and body movement. Now doctors can rely on imaging, rather than patient feedback, to understand what’s happening as they operate and to make sure the electrodes are in the right place.
Most patients spend the night at the hospital and return home the next day after surgery.
DBS & Parkinson’s
For Parkinson’s, your neurosurgeon will make a dime-sized incision in your skull to implant the leads directly into a deep part of your brain. If that makes you nervous, know that this is a highly established procedure that has only improved since the Food and Drug Administration first approved its treatment of movement disorders in 1997.
DBS & Essential Tremor
For essential tremor, DBS works similarly to DBS for Parkinson’s. However, your neurologist might also recommend focused ultrasound—that is, using ultrasound sound waves to affect the same part of the brain but with no cuts or incisions.
DBS & Epilepsy
For epilepsy, deep brain stimulation targets a different part of the brain than for Parkinson’s or essential tremor, called the anterior nucleus of the thalamus. This is effective at reducing the frequency of seizures and improving quality of life.
Deep Brain Stimulation Risks
As with any surgical procedure, there are risks and potential complications:
- Infection (that can occur in 4% of patients implanted with a neuromodulation device)
- Bleeding
- Stroke caused by DBS electrodes
You could also experience temporary pain and swelling in the implantation site, seizure, headache, confusion and difficulty concentrating. The neurotransmitter could also break or malfunction, which would require another surgical operation.
Follow-Up After DBS Surgery
You will meet with your neurologist 4–6 weeks after surgery. Your neurologist will program your device to deliver the right amount of electrical stimulation for you and your symptoms. You will not feel any pain while they program the device but you might feel some discomfort. You'll continue to meet with your neurologist regularly to fine-tune the settings in the following months.
When everything is functioning properly, the pulse generator sends electrical impulses to the electrodes. These impulses interfere with and block the electrical signals that cause your symptoms.
DBS surgery isn’t a cure for movement disorders, epilepsy, or OCD. However, it can give you a new lease on life.
Next Steps
You will need to get a referral from your neurologist or primary care provider to see a neurosurgeon who specializes in DBS surgery.
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