Deep brain stimulation (DBS) is a surgery that connects electrodes to your brain. These electrodes send electrical signals to your brain. This helps with problems related to how the brain works.1
It’s a choice people make to have surgery. Doctors put these electrodes in certain parts of the brain. This way, they can send special electrical signals to change how the brain works. The system has three parts: the electrode, a wire, and a generator placed under your skin. This is usually placed in the chest area. This system helps control unusual brain patterns and fix chemical imbalances.
Key Takeaways
- Deep brain stimulation is a neurosurgical procedure that uses implanted electrodes to treat various neurological conditions.
- DBS can help manage the symptoms of Parkinson’s disease, essential tremor, dystonia, epilepsy, and obsessive-compulsive disorder.
- The DBS system consists of an electrode or lead, an extension wire, and an internal pulse generator (IPG) implanted under the skin.
- Over 160,000 people have been treated using Deep Brain Stimulation for various neurological conditions.1
- DBS has been approved by the FDA to reduce seizures in hard-to-treat epilepsy.2
Understanding Deep Brain Stimulation
Deep brain stimulation, or DBS, is a surgery where electrodes are put in your brain. These electrodes send small electric shocks.3 They correct problems in the brain that cause many brain and mental health issues.
What is Deep Brain Stimulation?
The DBS system uses electric shocks to fix the brain’s wrong signals.3 It gets rid of chemical mix-ups and fixes brain signals that cause problems.
How Does Deep Brain Stimulation Work?
DBS fixes the brain signaling mistakes that create things like shaking or trouble moving.3 The electric zaps from the DBS system interrupt these bad signals, reducing the symptoms of many conditions.
Components of the DBS System
The DBS system has three parts:3
| Component | Description |
|---|---|
| Electrode or Lead | Placed in brain areas to send electric shocks |
| Extension Wire | Links the electrode to the pulse generator |
| Internal Pulse Generator (IPG) | Put under skin near chest, powers the system |
The DBS system works by sending small electric shocks to the brain. It fixes the abnormal brain activities that cause different problems.
Conditions Treated with Deep Brain Stimulation
Deep brain stimulation, or DBS, is a common treatment for Parkinson’s disease. It helps patients who find little relief from drugs. With DBS, the shaking, slowness, and stiffness, or the motor symptoms of Parkinson’s, can be managed well.1
Parkinson’s Disease
Essential tremor causes shaking, usually in the hands and arms. It’s a common and bothersome condition. For serious cases where the tremor makes daily activities hard, DBS can be a great help. It eases shaking and improves quality of life.2
Essential Tremor
Dystonia makes muscles contract without control, leading to twisted postures. When medicines aren’t enough, DBS is a valuable option for reducing these uncontrollable movements. It can offer relief where other treatments fail.2
Dystonia
The FDA also approved DBS for difficult-to-treat epilepsy, a condition that causes seizures. In epilepsy, DBS targets the thalamus’s anterior nucleus, which helps control where seizures start in the brain. This treatment can reduce seizure episodes.2
Epilepsy
For obsessive-compulsive disorder (OCD), DBS shows potential as a remedy. Though more study is necessary, evidence points to the effectiveness of DBS for severe and resistant OCD. It targets areas like the internal capsule or the nucleus accumbens.12
Obsessive-Compulsive Disorder
Deep Brain Stimulation: Uses, Benefits, and Risks
Deep brain stimulation (DBS) is a treatment for neurological and psychiatric issues. This includes Parkinson’s disease1, essential tremor3, dystonia3, epilepsy2, and obsessive-compulsive disorder (OCD)3. Over 160,000 people have used DBS across the globe. It has shown great success, especially for severe essential tremor and when dystonia doesn’t improve with medicines.
2 The FDA has okayed DBS to lessen seizures in tough epilepsy cases. Research hints that it might help with depression, OCD, and Tourette disorder, but we need more studies. These would show how safe and useful it is for these conditions.
1 Depending on the person’s symptoms, DBS can target one or both sides of their brain. A Vanderbilt University study looked at DBS for early Parkinson’s patients, finding it might be useful. For OCD, studies say treating both sides of the brain is better than fake treatments.
1 For some epilepsy types, a different study noted the long-term benefits of DBS. When comparing DBS places for Parkinson’s, both were equally good at helping with movement. Another Parkinson’s study found DBS helped improvement last over three years.
1 Older people and those with certain health issues might face more risks from DBS surgery. Surgery risks include electrode misplacement and brain issues. After surgery, some side effects might happen, like seizures and infections.
2 DBS therapy might lead to strange body feelings or difficulties with speech and balance. A person might feel dizzy or experience changes in vision or mood. The treatment involves a device sending small but regular pulses of electricity to the brain. This can help control symptoms, but it isn’t a cure. Sometimes, ongoing medication is still needed.
2 The therapy’s success can vary. Not everyone will find it helpful. The device needs battery changes over time. DBS is under investigation for use in other conditions like chronic pain and depression.
2 A few rare cases have linked DBS to possible movement issues for swimming. To be safe, talk to your doctor before any swimming activity after this therapy.
Candidate Evaluation for DBS
Ideal Candidates for Parkinson’s Disease
For those with Parkinson’s disease, the best DBS candidates are those whose symptoms really affect their daily life. They must respond well to medicines like levodopa.3 These patients often deal with severe tremors, big swings in motor function, or problems with their medicine’s side effects.3
Factors Affecting Candidacy
Not everyone suits DBS surgery. Problems with balance, walking, or speech can be roadblocks, alongside persistent confusion or tricky psychiatric issues.3 For folks 70 and up, or with issues like cerebrovascular disease and high blood pressure, the risks go up.1
First, patients considering DBS must go through a detailed check to see if they’re a match. Doctors look at how well they respond to levodopa, make sure their thinking is clear, and address any non-motor problems.3 There are different techniques for DBS surgery, depending on what’s best for each patient, including both stereotactic and image-guided methods.3
Pre-Surgical Testing and Evaluation
Before deep brain stimulation (DBS) surgery, Parkinson’s patients are thoroughly checked. Their symptoms must respond to levodopa to be considered for surgery.2
Confirming Levodopa Responsiveness
Doctors look closely at the patient’s symptoms and how they react to levodopa. This is crucial to see if they will benefit from DBS.2
Cognitive Assessment
The evaluation also checks the patient’s thinking and memory. It’s important for them to be able to take part in the surgery and follow-up care afterwards.2
Additional Evaluations
In some cases, more tests, and meetings with specialists might be needed before surgery. These can include:
- Neuropsychological testing to look at how the brain works from a psychological viewpoint
- Imaging studies with MRI or CT to see the brain’s structure
- Electrophysiological testing which looks at the brain’s electrical activity
- Consultations with various specialists to discuss the best approach, including neurologists, neurosurgeons, and neuropsychologists
All these help the healthcare team make sure DBS is right and prepare a detailed treatment plan for the patient.21
The Deep Brain Stimulation Procedure
The deep brain stimulation procedure has two main steps.
Lead Implantation
The first part involves the patient being awake. The neurosurgeon uses detailed images like MRI or CT scans to find the best spot in the brain for the DBS lead.1 They then insert the lead, with electrodes, into this spot.1 Where they place the lead is critical. It’s how they target the brain area causing the patient’s symptoms.
Neurostimulator Implantation
In another operation, the patient is asleep under general anesthesia.2 The surgeon cuts near the collarbone and makes a space under the skin for the IPG.2 A wire from the brain’s lead is passed under the skin to the IPG.2 The IPG has the battery and electronics to send electrical pulses. They put it in the pocket and close up the cut.2
Stereotactic DBS vs. Image-Guided DBS
There are two key ways to go about the deep brain stimulation procedure: stereotactic DBS and image-guided DBS.3
Stereotactic DBS uses a special frame to keep the patient’s head steady. This frame helps the surgeon guide the electrode to the right spot in the brain.3 The patient stays awake but calm during the surgery.
On the other hand, image-guided DBS is done while the patient is asleep from general anesthesia. The surgeon relies on detailed brain images from MRIs or CT scans to place the electrode accurately.3 There’s no frame needed in this method, giving more freedom in electrode placement.
Both types of DBS surgeries are known to work well. Some hospitals offer both methods. This lets the surgeon choose what’s best for each patient, considering their unique situation.3
| Stereotactic DBS | Image-Guided DBS |
|---|---|
| Uses a specialized head frame to precisely guide the lead | Utilizes advanced brain imaging to guide the lead without a frame |
| Performed under local anesthesia with mild sedation | Performed under general anesthesia |
| Keeps the patient awake and responsive during the procedure | Patient is unconscious during the procedure |
| Allows for more precise lead placement based on predetermined brain coordinates | Offers more flexibility in lead placement based on imaging guidance |
Post-Operative Programming and Adjustment
After DBS surgery, the patient will start an important phase. They need to program and adjust the DBS device. It’s critical for making DBS treatment work well and dealing with any side effects.3
A health team, often led by a specialist, works with the patient. They fine-tune the electrical settings of the DBS. This means they may change the voltage and other settings for better results.3
Many check-ups will follow to see how the patient reacts to the settings. The team then makes slow changes. They do this to make sure the patient doesn’t have problems like trouble speaking or balancing. If there are issues, they adjust the DBS settings.2
The DBS might also need regular care, like changing the battery. When the generator’s battery runs low, a simple surgery is done. This makes sure the patient’s therapy doesn’t stop.2
Managing the DBS is a joint effort. The patient and their medical team must work closely. They need to watch carefully to treat conditions like Parkinson’s disease and others. The goal is to get the best results.2
| DBS Programming and Adjustment | Key Considerations |
|---|---|
| Electrical Stimulation Parameters | – Voltage, frequency, and pulse width adjustments – Tailored to individual patient’s needs |
| Follow-up Visits and Monitoring | – Multiple appointments to optimize settings – Address any side effects or issues |
| Battery Replacement | – Outpatient procedure when power source depletes – Ensures uninterrupted DBS therapy |
| Collaborative Patient-Provider Effort | – Ongoing management and monitoring – Achieving best outcomes for underlying condition |
Potential Risks and Side Effects
Deep brain stimulation is often safe. Still, risks come with the surgery. There’s a 1% chance of brain hemorrhage. This includes a stroke.1
Problems from the surgery can be severe. These issues range from misplaced wires to infections. Some might face breathing problems or nausea. Heart issues and seizures are possible too.2
Surgical Risks
After surgery, side effects may show up. These can be infections, headaches, or confusion. Strokes, problems with the hardware, and some pain or swelling are also possible.2 When the device is working, there might be tingling or muscle sensations. Some could have speech or vision problems and find it hard to keep balance.1
Results from the stimulation can vary a lot. It might help ease symptoms but not cure the problem. Medication may still be needed.2 The surgery is riskier for those over 70 or with certain health issues. For some, tremors could get worse if the treatment stops.1 Not everyone sees big improvements.1
