Deep brain stimulation (DBS) is a surgery to implant electrodes in targeted areas within your brain. These electrodes provide electrical pulses in your brain. They are connected to a small device (called a pulse generator or neurostimulator) that is implanted under your skin, below your collarbone.
Similar to a heart pacemaker, the device sends electrical signals to targeted areas of your brain to modify the activity causing your symptoms.
DBS can be effective in managing some of the symptoms of movement disorders and other conditions like epilepsy and OCD. Although not a cure, DBS can improve your quality of life by decreasing the amount of time your symptoms are not well-controlled by medications.
Conditions Treated With DBS at Rush
- Parkinson's Disease
- Essential Tremor
- Tourette Syndrome
- Obsessive Compulsive Disorder (OCD)
Types of DBS at Rush
Your providers will discuss which type of DBS would be the best option for your situation.
- Asleep DBS: The entire procedure is performed under general anesthesia so you are not awake during the surgery.
- Awake DBS: You are awake during the first stage of the surgery.
- Directional DBS: The electrodes in your brain have the ability to stimulate in different directions vs. stimulating everything around them.
- Responsive DBS: The system senses your brain activity; when there is abnormal movement activity (e.g., stiffness or tremors), sensors turn on stimulation automatically. With responsive DBS, you are not receiving continuous stimulation.
Asleep DBS Benefits
Having brain surgery while awake creates anxiety for many of our patients. With asleep DBS, you are under general anesthesia for the whole procedure.
Here's how it works:
- A neurosurgeon places electrodes at the target selected before your surgery.
- The neurosurgeon uses imaging and guidance during the surgery (known as intraoperative imaging) vs. the cellular recordings used in awake DBS. This allows you to sleep through the entire procedure.
- Placement of DBS electrodes while you are asleep is just as safe and effective as traditional placement using awake surgery, according to research studies conducted over the last 10 years.
Who is a Good Candidate for Deep Brain Stimulation?
There are two main predictors of whether DBS will be effective for you:
- How well your medications control your symptoms
- Your overall physical and mental health
For epilepsy, you may be a good candidate for DBS if you:
- Are at least 18 years of age
- Have a history of partial-onset seizures (with or without generalization)
- Have tried three or more anti-seizure medications, and they did not reduce your seizures
- Have had more than six seizures per month (on average) for the last 3 months with no more than 30 days between seizures
- Have had EEG and MRI studies to evaluate your seizures
For movement disorders, you may be a good candidate for DBS if you:
- Have a good response to your medicine, but it is not maintained throughout the day
- Take a complicated medication schedule, but still have periods when your medications don't work
- Have trouble walking, but walk well when your medicines are working
- Experience significant and damaging side effects from your medications
- Are under the age of 75
- Are in good physical health otherwise
- Are not cognitively impaired (e.g., do not have memory loss, dementia, hallucinations)
- Do not have any late-stage Parkinson's complications, including incontinence or falling when your medications are working
- Do not have depression
DBS Surgery at Rush
Stage 1: Determining where to place the DBS lead
Depending on whether you have awake or asleep DBS, you will be awake (under local anesthesia) or asleep (under general anesthesia).
Your neurosurgeon will do the following:
- Create small openings in your skull and place a small wire in your brain (the lead).
- Test the lead to make sure it is connected to the area of your brain causing your symptoms.
- Conduct neurological tests to determine the safest place in your chest for the stimulator.
Stage 2: Placing the stimulator
You will be asleep under general anesthesia for this stage of the surgery.
Your neurosurgeon will do the following:
- Make a small opening below your collarbone to implant the neurostimulator.
- Make another small opening behind your ear and pass an extension wire (under the skin) through your head, neck and shoulder.
- Use the extension wire to connect the lead in your brain to the neurostimulator.
- Close the openings, hiding the neurostimulator device and the wires.
After surgery: Stimulator programming
Four weeks after surgery, you will see your neurologist for your first programming appointment. Programming is simple and painless; it does not involve additional surgeries or sedation.
- Your neurologist will turn on the stimulator and adjust the settings to determine the best one for your symptoms.
- It can take several adjustment appointments to find a setting that improves your symptoms.
- Once your doctor has found a setting that works for you, you will need minor adjustments two or three times a year or if your symptoms change.
- At Rush University Medical Center, movement disorder patients who have the Abbott Infinity DBS System can now choose to do some or all of their follow-up visits virtually. Using a new system called NeuroSphere Virtual Clinic, your doctor can prescribe treatment settings and ensure that the device is working properly via a secure video chat. You can do these visits anywhere — all you need is a cellular or WiFi connection and a sufficiently charged controller — so you don’t have to go come to our office every time you need your device adjusted.
- While rare, it is possible that DBS will not provide any improvement in your symptoms. If you do not experience any change — or if your symptoms get worse — talk to your neurologist about your options and the possibility of turning off your DBS.
Rush Excellence in Deep Brain Stimulation
- Movement disorders expertise: The Rush movement disorders team is among the largest in the world and treats more than 6,000 patients with movement disorders each year. They have experience addressing the wide variety of symptoms that can affect your quality of life.
- Finding the right candidates for DBS: A successful outcome for DBS starts with good patient selection for the procedure. Our specialists have the expertise to know who will be a good candidate for DBS — and equally important, who is not likely to benefit from it.
- Multiple types of DBS available: Rush is one of the first in the region to offer asleep DBS. Asleep DBS offers an alternative to patients who would rather live with debilitating symptoms than undergo awake DBS. With asleep DBS, you are asleep throughout the surgery and experience similar outcomes. We also offer directional DBS and responsive DBS, both of which offer more targeted neurostimulation. This can reduce your chances for side effects while giving you relief from your symptoms.
- Telemedicine option for DBS stimulator adjustments: Rush is one of the first in the nation, and the only center in Illinois, to offer Abbott’s NeuroSphere Virtual Clinic — which enables our movement disorder physicians to both communicate with their patients and adjust patients’ neurostimulation devices in real time via video chat. The NeuroSphere Virtual Clinic, the first technology of its kind, gives patients who have the Abbott Infinity DBS System the flexibility of receiving adjustments from anywhere while receiving the same level of care as they would get during an in-person visit to our movement disorders clinic. It’s a convenient way to ensure that your DBS settings are effectively controlling your symptoms and, if not, fine-tune the settings without having to go to the doctor’s office every time.
- Alternatives for people who aren't DBS candidates: Rush is the first in Illinois to offer focused ultrasound to control parkinsonian tremor and essential tremor. Focused ultrasound is a potential nonsurgical option if you are not a candidate for DBS. It uses sound waves to target specific areas in the brain that cause tremor.
- DBS for epilepsy experience: DBS is approved by the FDA for use in patients whose epilepsy does not respond to medication (known as intractable epilepsy) and who are not candidates for epilepsy surgery. The Rush epilepsy team was part of the clinical trials that led to the FDA approval of DBS to treat epilepsy.