Deep Brain Stimulation

Deep brain stimulation is a type of treatment for symptoms of neurological disorders, mainly Parkinson’s disease. It involves a surgery where leads or wires are placed onto the brain, and a small device, called a neurostimulator [noo-roh-STIM-yuh-ley-ter], is placed under the skin, usually near the collarbone. The neurostimulator sends signals to the leads in your brain to treat conditions like Parkinson’s disease. The procedure is done is 2 stages, and the results of the procedure can’t be seen from outside of the body. Learn more about deep brain stimulation.

Deep brain stimulation [STIM-yuh-ley-shun], or DBS, is a surgery done to put a device into your body that sends electrical signals to your brain. It is most often used to treat the tremors and stiffness that come with Parkinson’s disease.

In the procedure, wires are placed into the brain, and a neurostimulator [noo-roh-STIM-yuh-leyt-er] (a device that sends electrical current) is also placed in the body. The neurostimulator then sends signals to the brain. The DBS system has 3 parts, including:

1. Wires, or leads, that are placed in the brain.
2. The neurostimulator, which is a small device that is placed under the skin. Usually it’s placed near the collarbone, but it can be put in other places, too.
3. Sometimes another thin wire is also needed to connect the lead with the stimulator.

The surgery will usually be done under general anesthesia [an-uhs-THEE-zhuh] and will require you to stay in the hospital for a few days after it is done.

Some of the risks of putting a deep brain stimulation device in your body may include:

• Feeling dizzy
• Having an allergic reaction to the device or wires
• Having a hard time concentrating
• Leaking brain fluid, which can cause headaches
• Having a hard time with speech
• Tingling feeling in other parts of the body
• Pain or swelling where the device is in your body

If the pieces of the system break or are moved out of place, symptoms can include:

• Needing to have another surgery to fix the broken pieces
• The battery on the device failing, which can happen after 3 to 5 years
• The wire that connects the device to your brain poking out of the skin
• The piece of the system in the brain breaking or moving (rare)

Some of the possible risks of having any brain surgery include:

• Blood clots
• Bleeding in the brain
• Coma
• Infection in the brain or skull
• Having short- or long-term problems with speech, balance, or other functions
• Seizures
• Stroke

Deep brain stimulation (DBS) can help with the symptoms of Parkinson’s disease when medicine hasn’t helped. DBS isn’t a cure, but it can make the symptoms less severe. Some of the symptoms of Parkinson’s disease that DBS may help relieve include:

• Tremors
• Problems walking
• Moving slowly
• Stiffness
• Having rigid movements

DBS can also be used to deal with some other conditions, including:

• OCD, or obsessive-compulsive disorder
• Chronic pain
• Tourette syndrome
• Major depression, if other treatments have failed
• Obesity
• Tremors in the arms

Before the surgery, your healthcare provider will do a physical exam. They will also do other imaging tests like a CT or MRI scan. These tests will give the doctor a picture of your brain so that they know where to put the wires. These imaging tests are also used during the surgery to help the doctor guide the placement of the device and wires.

There may be more than one specialist who helps you during the DBS procedure, including:

• Neurologists [noo-ROL-uh-jists]
• Neurosurgeons [noor-oh-SUR-juhns]
• Psychologists [sahy-KOL-uh-jists]

Be sure to tell your doctor about any medicines you’re taking, including over-the-counter medicines, supplements, inhalers, liquid medicines, and patches.. Also let them know if you’re pregnant or have been drinking a lot of alcohol.

In the days leading up to the surgery, your doctor may give you instructions to stop:

• Taking certain medicines, like blood thinners, ibuprofen, aspirin, or others
• Smoking, if you can
• Eating or drinking anything so many hours before the surgery

You will also need to:

• Wash your hair using a special kind of shampoo.
• Take all medications as your doctor advises.

DBS is usually done in 2 separate surgeries.

During the first surgery, adults will receive a shot to numb the area where the procedure will happen, and children are given general anesthesia. Here’s what to expect:

• Your head will be placed into a frame to keep it from moving. In some cases, the procedure is done in an MRI machine.
• A small opening is then drilled into the skull, and the lead is placed into the brain.
• Sometimes, the doctor may need to drill an opening on both sides of the head to insert 2 leads.
• The first electrical impulses may be sent during the procedure to make sure the leads are connected.

During the second surgery, you will be asleep so that there is no pain during the procedure. Here’s what to expect for this second surgery:

• The doctor will make a small opening, typically below the collar bone. They will place the neurostimulator into the opening.
• The wire that connects to the leads in the brain goes through the skin of the head, neck, and shoulder to connect to the neurostimulator.
• The opening is then closed. You won’t see the device or the wire outside of your body.

You may need to stay in the hospital for a few days after the surgery. You will also get a prescription for medicine to prevent infection.

Once the procedure is complete, impulses can be sent to your brain to see if the neurostimulator lessens the symptoms of the condition it is meant to treat. Some fine-tuning of the impulses may be needed so that they can be as effective as possible.

Sometime after the surgery, you’ll visit your doctor again to have the device turned on. This is not another surgery, just a visit to figure out how much stimulation needs to be sent.

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

• Problems with vision
• Any pain
• Itching
• Hives
• Headaches
• Redness
• Swelling
• Irritation
• Nausea or throwing up
• Fever
• Weak muscles

Another surgery may be needed after 3 to 5 years to replace the batteries in the stimulation device.