Deep Brain Stimulation

Deep brain stimulation, or DBS, is a surgical treatment to implant electrodes in targeted areas within your brain. These electrodes provide electrical pulses in your brain to help manage your symptoms. They are connected to a small device, called a pulse generator or neurostimulator, that is implanted under your skin, below your collarbone.

You may think of the device as a brain pacemaker. Similar to a heart pacemaker, it sends electrical signals to targeted areas of your brain to modify the activity causing your symptoms.

When medications don’t provide enough relief, DBS can be effective in managing some symptoms of the following:

• Movement disorders, including Parkinson’s disease, dystonia and essential tremor
• OCD
• Epilepsy

Although not a cure, DBS is a type of neurostimulation therapy that can improve your quality of life by reducing the amount of time your symptoms are not controlled well by medications.

• Some of the possible benefits of DBS include the following:
• Reduced tremors, stiffness and involuntary movements
• Improved independence
• Reduced need for complex medication schedules

The procedure is adjustable and reversible, with settings that can be fine-tuned over time

Types of DBS at Rush

Your providers will discuss which DBS options would be the best for your situation. These include the following:

• The method of surgery:
  • 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. This allows you to respond to testing in real time during the procedure. You may feel some pressure, but the surgery is generally painless.
• The device. The Rush Movement Disorders team expertly manages all three device manufacturers and will discuss the best device options for you and your symptoms, including:
  • Image guidance for programming: The system will create a 3-D map of your brain to help your programming neurologist quickly find the best location and parameters for stimulation.
  • Adaptive DBS: If you have the Medtronic Percept system, the system can sense your brain activity and will adjust stimulation in response to that activity throughout the day. This is currently only available for Parkinson’s disease patients and is best for patients who have fluctuations in their symptoms throughout the day in relation to their medications.
  • Virtual DBS: If you have the Abbott Infinity DBS System you can choose to do some follow-up visits virtually depending on your location and insurance approvals.

Benefits of Asleep DBS

Having brain surgery while awake may create anxiety for some 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, that differ from the types of 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 several years.

Signs You May Need Deep Brain Stimulation

There are several symptoms and signs that can indicate you may need DBS. But these alone may not make you a good candidate for the procedure. You will need to discuss options with your specialist to make sure you’re getting the most appropriate treatment.

Some signs that DBS may benefit you include the following:

• Parkinson’s symptoms, such as tremor, stiffness or slowed movement, are not responding well to medication
• Parkinson’s medications are causing motor complications, such as fluctuations or dyskinesias
• Essential tremor is interfering with everyday tasks
• Dystonia comes with painful, involuntary muscle contractions
• OCD or epilepsy has not improved with standard therapies

Who Is a Good Candidate for Deep Brain Stimulation?

There are a few main predictors of whether DBS will be effective for you:

• In cases of Parkinson’s, how well your medications control your symptoms
• Whether your tremors or dystonia symptoms are not responding to medication and are causing disability
• 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 antiseizure medications that did not reduce your seizures
• Have had more than six seizures per month on average for the last three 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 Parkinson's disease that responds well to your medicine, but it is not maintained throughout the day
• Take a complicated medication schedule and still have periods when your medications don't work
• Have Parkinson’s disease that causes trouble walking, but you walk well when your medicines are working
• Experience significant and damaging side effects from your medications
• Have tremors or dystonia symptoms that do not respond to medication and are causing disability
• Are under age 75 — careful evaluation may be needed to consider this therapy in older adults
• Are in good physical health otherwise
• Are not cognitively impaired; for example, you do not have memory loss, dementia or 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

DBS is performed in three main stages. First, the neurosurgeon places the lead, which is the wire that connects to the targeted area of your brain. Next, they place the neurostimulator, which generates electrical pulses, and connect it to the lead. Finally, they adjust the stimulator settings to best address your symptoms.

Stage 1: Placing the DBS lead

Depending on whether you have awake or asleep DBS, you will either 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, the lead, in your brain
• 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

About 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.

Stimulator programming involves the following:

• Your neurologist turns on the stimulator and adjusts 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.

While rare, it is possible that DBS will not improve 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.