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Deep Brain Stimulation (DBS) Surgery

Surgery Overview

Deep brain stimulation (DBS) uses electrical pulses to stimulate an area of the brain. This can change the activity in that area of the brain. You will need surgery to implant the devices that stimulate the brain.

Most often, DBS is used to relieve symptoms of Parkinson's disease when they can't be controlled by medicines. But it can also be used for other conditions, such as multiple sclerosis and obsessive-compulsive disorder.

The devices are implanted in two steps. First, your doctor will drill two small holes in your skull. Then he or she will place tiny wire electrodes in your brain. You may be awake during the surgery so that you can help the doctor place the electrodes where they will work best. But your doctor might also use a type of imaging (MRI) to help place the electrodes.

It may seem scary to be awake during this surgery. But your scalp will be numb. You won't feel any pain.

The second step is to implant a small, battery-powered generator. It's placed under the skin of your chest near your collarbone. This device is then connected to the electrodes in your brain. To do this, the doctor will use a small wire that runs under your scalp and skin. You won't be awake for this surgery.

After the surgery, you will have a short hospital stay. The generator will be turned on before you go home.

What To Expect

You will stay in the hospital for several days after the procedure while your doctor checks the effect of DBS.

Why It Is Done

DBS may be used to relieve symptoms of Parkinson's disease, especially tremor, when they can't be controlled with medicine. It's the surgical treatment of choice for Parkinson's disease. That's because it works better, is safer, and is less harmful to brain tissue than other surgical methods.

DBS of the thalamus is done to treat both disabling tremor caused by Parkinson's disease and essential tremor.

Procedures that stimulate the subthalamic nucleus and the globus pallidus are done to help control a wider range of symptoms (along with tremor). They are used more often than stimulation of the thalamus. Symptoms that are most often helped (besides tremor) include problems with changes between "on" and "off" time and dyskinesia. Symptoms that are less likely to get better include problems with walking, balance, and speech. In some cases, DBS can make these problems worse.

DBS may also be used to treat severe tremor related to multiple sclerosis (MS). It usually is a last resort after all other options have been tried without success to treat MS tremor. Only people with severe tremor are candidates.

How Well It Works

DBS of the thalamus works well to reduce tremor. It does not affect slow movement (bradykinesia), stiffness (rigidity), or other symptoms.footnote 1

Compared to medicine for Parkinson's disease, DBS of either the subthalamic nucleus (STN) or globus pallidus (GPi) gave people almost 5 more hours of "on" time on average each day.footnote 2

Two studies compared DBS of the STN to DBS of the GPi. The studies showed equal effects on the symptoms of Parkinson's disease after 2 and 3 years.footnote 3, footnote 4

  • The group who had DBS of the STN was able to take less medicine for Parkinson's disease after 2 or 3 years compared to the group who had DBS of the GPi.
  • After 2 years, the group who had DBS of the GPi had less depression and problems thinking than the group who had DBS of the STN. But after 3 years, there was no difference in depression between the two groups.
  • Quality of life was similar between the two groups.

Risks

Risks of DBS include:

  • Infection or skin irritation caused by the device in the chest (stimulator) or by the wires or electrodes.
  • Bleeding in the brain during the surgery, resulting in a stroke.
  • Numbness, tingling, twitching, or other abnormal sensations when the device is turned on. (These usually don't last long and can be stopped by adjusting the programming of the deep brain stimulation device.)
  • Problems with the device, such as:
    • A break in the wire leading from the electrode to the stimulator.
    • Movement of the wires or the device under the skin.
    • Need for a new battery for the device. A battery typically will last about 5 years.
    • Failure or malfunction of the stimulator or the electrodes.
  • Psychological problems, such as apathy and depression.
  • Problems with thinking, memory, speech, or swallowing.
  • Trouble with walking or balance and an increased risk of falling.
  • Seizures.

References

Citations

  1. Samii A, et al. (2004). Parkinson's disease. Lancet, 363(9423): 1783–1793.
  2. Weaver FM, et al. (2009). Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease. JAMA, 301(1): 63–73.
  3. Follett KA, et al. (2010). Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. New England Journal of Medicine, 362(22): 2077–2091.
  4. Weaver FM, et al. (2012). Randomized trial of deep brain stimulation for Parkinson disease: Thirty-six-month outcomes. Neurology, 79(1): 55–65.

Credits

Current as of: August 4, 2020

Author: Healthwise Staff
Medical Review:
Anne C. Poinier MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
G. Frederick Wooten MD - Neurology