Deep Brain Stimulation (DBS) Procedure

How does deep brain stimulation work

DBS has helped people remain in their careers, care for their families, resume favorite activities and once again do simple things in daily life.

Clinical studies have shown that deep brain stimulation surgery, when added as treatment for Parkinson’s disease patients:

  • Provides possibly up to five additional hours of good movement control daily with medications, when compared to medication therapy alone.
  • Improves quality of life and makes routine daily activities easier.
  • In some cases, may significantly reduce medication use, which can result in fewer side effects related to the medications.

What to expect during DBS surgical procedure

Deep brain stimulation therapy uses a small, pacemaker-like device to send electrical signals to an area in the brain that helps fine-tune and control movement. The electrical brain stimulation may, in some instances, block some of the brain messages that cause involuntary and disabling motor symptoms. The device is implanted under the skin in the chest. Small, thin wires connect the device to your brain so the signals can reach the source of your symptoms in your brain.

After the system (also called a deep brain stimulator) is implanted, your health care provider adjusts the settings to optimize the DBS therapy for you. The process can take several programming sessions to optimize for your specific conditions. The settings can be adjusted in the future if your symptoms change.

Most people do not feel the stimulation, and some may sense a brief tingling when the stimulation is first activated. A few weeks after the procedure, most patients are able to resume normal daily activities. Your DBS clinician will provide guidance on when you can try activities that had become difficult for you prior to deep brain stimulation surgery.

The surgery can vary in length but typically takes several hours. Patients usually arrive the morning of the procedure having not taken their movement disorder medication that day, undergo the procedure, and then stay in the hospital after the surgery is complete. Typically, if everything goes well, they will be able to go home the following day. Afterwards, patients may experience discomfort and soreness that can be managed with pain medication.

Implanting the leads

In the first part of the procedure, your neurosurgeon places thin wires called leads into a precise part of your brain. Your brain is mapped with an MRI or CT scan to determine the exact location where leads need to be implanted. You will be awake through some parts of the surgery so you can help your surgeon determine the best place for the lead. Other times you will be sedated and even asleep for your comfort. You will not experience pain during the actual lead placement.

Your surgeon may stimulate areas of your brain while you move your arms or legs, tap your fingers, move your hands, or pretend to drink from a cup. This helps your surgeon find the best lead position to control symptoms like tremor, rigidity, or slowness of movement to have the most benefit with the least amount of side effects from brain stimulation.

Implanting the neurostimulator

The neurostimulator is the device that sends the electrical impulses to the leads that have been inserted into the brain. It may be implanted the same day or later. You will be sedated and asleep for this part of the procedure. The neurostimulator is implanted under the skin of your chest just below the collarbone. The surgeon will also connect the leads to the neurostimulator with extensions that are placed under the skin and up from the chest to your neck and head.

DBS surgery recovery and healing

Patients are usually able to return home the day after DBS surgery. Healing can take several weeks, with any pain managed through medication. Typically, your device will not be activated until your first programming session. We generally recommend avoiding strenuous activity, and arm movements above the shoulder for the first several weeks after implantation of the device. Timing on trying more strenuous activities that were difficult before your surgery should be discussed with your doctor first.

DBS programming sessions

After you have healed from surgery — typically a few weeks after the procedure — your health care provider will program the device to best control your individual symptoms while minimizing side effects. Follow-up sessions are opportunities to further adjust settings to optimize the therapy for you.

Periodic adjustments are also a normal part of DBS therapy. After the initial programming, people with tremor may feel a brief tingling sensation, and usually experience relief from symptoms almost immediately. But results may vary as some may take months of programming before they experience the maximum benefit of DBS therapy. You may have a controller that allows you to adjust the settings at home, turn it off and on, and monitor the battery life.

Are there risks with DBS surgery?

Brain stimulation therapy requires brain surgery. Risks of brain surgery may include serious complications such as infection, bleeding inside the brain, strokes, and less likely seizures, and coma. Some of these may be fatal. Fortunately, many of these serious risks are very rare and overall, the procedure is very well tolerated.

Other potential risks of DBS surgery are that once implanted, the system may become infected, parts may wear through your skin, and the lead or lead/extension connector may move. DBS therapy could suddenly lose efficacy because of mechanical or electrical problems. Any of these situations may require additional surgery or cause your symptoms to return.

Be sure to talk to your doctor about any questions or concerns you may have.

While DBS may be new to you, it’s been helping people with Parkinson’s disease and other movement disorders for more than 10 years around the world. More than 100,000 patients have received successful DBS therapy for Parkinson’s disease, dystonia, and essential tremor.