Deep brain stimulation


Definition

Deep brain stimulation (DBS) uses a device called a neurostimulator to deliver electrical signals to the areas of the brain that control movement, pain, mood, weight, and awakening.

Alternative Names

Globus pallidus deep brain stimulation; Subthalamic deep brain stimulation; Thalamic deep brain stimulation; DBS; Brain neurostimulation

Description

The DBS system consists of three parts:

Surgery is done to place each part of the neurostimulator system. In adults, the whole system can be placed in 1 or 2 stages (2 separate surgeries).

Stage 1 is usually done under local anesthesia, meaning you are awake, but pain-free. (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, electric 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 symptoms of certain diseases.

Why the Procedure is Performed

DBS is commonly done for persons with Parkinson disease when the symptoms cannot be controlled by medicines. DBS does not cure Parkinson disease, but can help reduce symptoms such as:

Deep brain stimulation may also be used to treat the following conditions:

Risks

DBS is considered safe and effective when done in the right people.

Risks of deep brain stimulation placement may include:

Problems may also occur if parts of the DBS system break or move. These include:

Possible risks of any brain surgery are:

Risks of general anesthesia 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 the exact part of the brain responsible for the symptoms. The images are used to help the surgeon place the lead in the brain during surgery.

You might have to see more than one specialist, such as a neurologist, neurosurgeon, or psychologist, to make sure that the procedure is right for you and has the best chance of success.

Before surgery, tell your surgeon:

During the days before the surgery:

The night before and on the day of surgery, follow instructions about:

After the Procedure

You may need to stay in the hospital for about 3 days.

The doctor may prescribe antibiotics to prevent infection.

You will return to your doctor's office at a later date after surgery. During this visit, the stimulator is turned on and the amount of stimulation is adjusted. Surgery is not needed. This is process is also called programming.

Call your doctor if you develop any of the following after DBS surgery:

Outlook (Prognosis)

People who have DBS usually do well during the surgery. Many people have great improvement in their symptoms and quality of life. Most people still need to take medicine, but at a lower dosage.

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 risks.

The DBS procedure can be reversed, if needed.

References

Altinay M, Estemalik E, Malone DA Jr. A comprehensive review of the use of deep brain stimulation (DBS) in treatment of psychiatric and headache disorders. Headache. 2015;55:345-50. PMID: 25660121 www.ncbi.nlm.nih.gov/pubmed/25660121.

Ho A L, Sussman E S, Zhang M, et al. Deep brain stimulation for obesity. Cureus. 2015;7(3):e259. PMID: 26180683 www.ncbi.nlm.nih.gov/pubmed/26180683.

Kumar A, Pandey AK, Okun MS. Clinical neurophysiology: neuromodulation. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 32D.

Schrock LE, Mink JW, Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group, et al. Tourette syndrome deep brain stimulation: a review and updated recommendations. Mov Disord. 2015;30:448-71. PMID: 25476818 www.ncbi.nlm.nih.gov/pubmed/25476818.

Whitworth LA, Burchiel KJ. Deep brain stimulation in movement disorders: Parkinson's disease, essential tremor, and dystonia. In: Quiñones-Hinojosa A, ed. Schmidek and Sweet's Operative Neurosurgical Techniques. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 114.

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