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Deep brain stimulation
Deep brain stimulation (DBS) is a surgical treatment in which a device called a neurostimulator delivers tiny electrical signals to the areas of the brain that control movement.
Globus pallidus deep brain stimulation; Subthalamic deep brain stimulation; Thalamic deep brain stimulation; DBS
The DBS system consists of three parts:
DBS requires surgery to correctly place each part of the neurostimulator system. DBS in adults usually involves two separate surgeries.
Stage 1 is usually performed under local anesthesia, meaning you are awake but pain-free. (If the procedure is done in children, general anesthesia is given.)
Stage 2 is done under general anesthesia, meaning you are asleep and pain-free. The timing of this stage of surgery depends on where in the brain the stimulator will be placed.
Once connected, electrical pulses travel from the neurostimulator, along the extension wire, to the lead, and into the brain. These tiny pulses interfere with and block the electrical signals that cause tremors and movement disorder symptoms, such as those that occur with Parkinson’s disease, essential tremor, or obsessive-compulsive disorder.
Why the Procedure is Performed
This surgery may be an option for patients with very severe Parkinson's disease symptoms that cannot be controlled by medications. The surgery does not cure Parkinson’s disease, but can help make reduce the severity of symptoms such as:
Deep brain stimulation may also be used to treat the following conditions:
DBS is considered to safe and effective when performed in properly selected patients.
Risks associated with deep brain stimulation placement may include:
Problems may also occur if parts of the DBS system break or move. For example, this may include:
Possible risks of any brain surgery are:
Before the Procedure
You will have a complete physical exam.
Your doctor will order many laboratory and imaging tests, including a CT or MRI scan. These imaging tests are done to help the surgeon pinpoint exact what part of the brain is responsible for the tremor and movement disorder symptoms. The images will be used to help the surgeon place the lead in the brain during surgery.
You might have to see more than one specialist (neurologist, neurosurgeon, psychologist, etc.) to make sure that the procedure is right for you and has the best chances of success.
Before surgery, always tell your doctor or nurse:
During the days before the surgery:
On the day of the surgery:
After the procedure
Most people who have DBS are in the hospital for about 3 days. The doctor may prescribe antibiotics to prevent a possibly infection.
You will return to your doctor’s office a few weeks after surgery so that the stimulator can be turned on, and the amount of stimulation can be adjusted, if necessary. This can easily be done, without further surgery. It is often referred to as “programming.”
Call your doctor if you develop any of the following after DBS surgery:
DBS is generally well tolerated and does not damage nerve cells like other surgical treatments for Parkinson’s disease. Many patients report significant improvement in their symptoms after having this treatment. However, most of them still need to take medication, although at lower doses, which improves their quality of life.
This surgery, and surgery in general, is riskier in people over age 70 and those with health conditions such as high blood pressure and diseases that affect blood vessels in the brain. You and your doctor should carefully weigh the benefits of this surgery against the potential risks.
The DBS procedure can be reversed, if needed.
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Reviewed by:Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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