What are the benefits of deep brain stimulation?

What is DBS?

Deep brain stimulation (DBS) helps control tremors by delivering tiny electrical signals into one of three target areas of the brain that control movement: Subthalamic Nucleus-STN; Globus Pallidus pars interna-GPi; and Ventral Intermediate Nucleus of the Thalamus-Vim. With DBS, a pacemaker-like device is implanted under the skin, and then electrodes are attached to specific areas of the brain that control movement.

DBS has been proven effective for Parkinson’s disease, essential tremor, epilepsy, dystonia and obsessive-compulsive disorder (OCD).

What are the steps involved in DBS surgery?

DBS surgery consists of three steps:

• Placement of an extremely thin, insulated wire known as a lead (electrode) into the brain
• Implantation of a device, known as generator (neurostimulator), near the collarbone
• Attachment of the lead and generator via a thin, insulated wire known as an extension

What are the types of DBS surgery?

There are currently two types of DBS: Asleep DBS and Awake DBS (traditional deep brain stimulation). Asleep DBS procedures are performed while you are under sedation, while traditional deep brain stimulation (awake DBS) is performed while you are awake. Both are safe and effective, yet each differ in surgery time, number of surgeries, electrode placement, and your ability to actively observe the process. Choosing a DBS procedure that best suits your needs should be discussed with your neurologist, neurosurgeon, and primary care provider. At the Denver DBS Center, we will work with your neurologist and primary care provider to provide this consultation to ensure we are all working together on your behalf.

What are the differences between Asleep DBS and Awake DBS?

While Asleep DBS and Awake DBS provide similar symptom relief for people with movement disorders, they each have different approaches.

Asleep DBS:

• Entails two surgeries, both of which are performed with the patient asleep.
• Entire procedure takes 2-3 hours.
• Electrode placement is typically within 1 millimeter of target, which is more accurate than placement with awake DBS.
• Electrode testing is not necessary.

Awake DBS:

• Requires four surgeries (for bilateral electrodes), two of which are performed while the patient is awake.
• Electrode placement takes 4-6 hours.
• Electrode placement is within 1-2 millimeters of target.
• Electrode testing conducted during surgery to ensure proper placement.

Awake DBS is considered the more traditional approach to DBS as it was first used in 1987. DBS was approved by the FDA in 1997 for essential tremor and 2002 for Parkinson’s disease.

The portable CT machine (CereTom®), used by neurosurgeons at the Denver DBS Center, was first used for Asleep DBS in 2011, which has made widespread Asleep DBS possible.

See the research confirming the safety of Asleep DBS and its improved electrode placement here.

What are the risks of DBS?

Risks associated with DBS are generally low. As with any brain surgery, hemorrhage, stroke, and bleeding can occur but the incident rate is less than 1%. Infection is also a possibility, although it’s very rare. Other risks may include headache, soreness at the incision sites, and stimulation-side effects like tingling of the face, vision problems, or balance issues.

In rare cases, the DBS device may malfunction or patients may not experience symptom relief.

Am I a candidate for DBS?

Guidelines for DBS differ for each condition, but generally you must must have moderate to severe symptoms of your disease, and you must respond well to drug therapies. Physicians, neurologists, and neurosurgeons commonly recommend that DBS be performed before you lose any abilities that may be critical to your quality of life.

Below are general criteria for DBS based on your condition.

Parkinson’s disease 

• Clear diagnosis of idiopathic (arising spontaneously) Parkinson’s disease
• Absence of dementia
• Any fluctuations in symptoms with levodopa therapy (Parcopa, Sinemet, Stalevo)
• At least some improvement with levodopa therapy
• Lack of serious disease preventing surgery
• No age parameters, but patients under 75 generally do better

Essential tremor

• Medications are ineffective in controlling your tremors
• Tremors interfere with your ability to socialize and prevent you from participating in activities you previously found enjoyable
• Tremors complicate everyday tasks like eating and writing

Dystonia

• Medications, including Botox, are ineffective in controlling your dystonia
• You are seven years of age or older

Obsessive-compulsive disorder (OCD) 

• DBS is currently being used on a case-by-case basis for OCD under a Humanitarian Device Exemption (HDE) from the FDA. You must meet several criteria in order to be considered a candidate for DBS.

Epilepsy

• Seizures failed to be controlled with at least two different types of anti-epileptic drugs (AEDs)
• General good health
• If you have been diagnosed with a mental illness, such as anxiety or depression, you may have been told you do not qualify for epilepsy surgery. However, often mental illness is a direct result of seizures and does not automatically eliminate you from qualification. We can provide an assessment to determine if you are a candidate for deep brain stimulation for epilepsy.

To qualify for DBS, you must also be in general good health, able to be exposed to MRI, and able to undergo surgery.

What should I consider before choosing DBS?

As with all surgical procedures, you should consider whether or not your symptoms can be controlled with medications or less invasive procedures.

DBS is reversible as it does not remove or change any portion of brain tissue.

What is recovery like following DBS?

Typically, patients who undergo DBS spend 1-2 days in the hospital following each surgery, although many patients can return home the day of the battery placement. Minimal pain at the incision sites may occur. Swelling and some bruising might also occur.

It may take a few weeks for full recovery and for medications and programming of the DBS device to provide symptom relief.

You might experience a “honeymoon phase” (also known as a microlesion effect) after surgery when your symptoms improve greatly. It’s important to continue with your medication regimen as monitored by your physician as this phase typically wears off. It make take a few months to for you to experience the full benefits of DBS.