Deep brain stimulation (DBS)
What is deep brain stimulation (DBS) treatment?
If you’re having significant disability despite the use of Parkinson’s disease medical treatment, you may be a candidate for a Parkinson’s disease surgical treatment called deep brain stimulation (DBS).
DBS is a procedure in which tiny electrodes are placed into the brain with the help of computer guidance. These electrodes are connected to a pacemaker-like device implanted beneath the collarbone, much like a cardiac pacemaker. Continuous electrical stimulation effectively jams or blocks the abnormal circuitry of the brain that occurs in disorders like Parkinson’s disease. The result is an improvement of many of the most disabling symptoms, which can lead to an improved quality of life for patients suffering from these diseases.
Deep brain stimulation is a safe and effective surgical procedure for Parkinson’s disease. However, like any surgery, there are potential risks. The potential risks or discomforts include:
- Bleeding, infection or other damage to the brain or its surrounding structures
- Malfunction of the system which may require replacement or removal of the device
- Temporary side effects from stimulation that can be alleviated by changing the stimulator settings
What to expect
The two stages of deep brain stimulation are:
- Stage 1: Implantation of the electrodes in the brain. This typically requires a two to three-day hospital stay.
- Stage 2: Placement of the pulse generators, or brain pacemakers, is performed seven to ten days after the first surgery. This is typically performed as an outpatient procedure.
In the week prior to your surgery, you’ll undergo pre-surgical testing that will include routine blood tests and a high-resolution MRI scan. At the time, of the procedure, a halo-like frame, known as a stereotactic head frame, will be placed on your head, and a CT scan will be performed. The CT scan information will be transferred to a computer where it will be merged with the previous MRI scan, and a target will be identified.
Once in the operating room, you’ll be placed under local anesthesia, a small access hole will be made in your skull, and an electrode will be placed into your brain using computer guidance. Using sophisticated monitoring devices, the operating room team will listen to the activity of the brain’s neurons, or nerve cells, to determine precisely where to place the electrode. If you’re undergoing a bilateral procedure, the procedure will be repeated on the other side of your brain. Once both electrodes have been placed, they are left under your scalp and the surgery is complete.
In Stage 2, the generator (pacemaker) devices are placed under your skin near your collarbone and connected to the electrodes with extension wires. The surgery takes approximately two hours. The generator is not usually activated until the wounds have healed.
Our Movement Disorder Center team will activate the generators and determine the optimal settings to obtain the maximum clinical benefit with minimal side effects. Over the first few months, the patient may need a number of adjustments in order to determine the best settings. Once the optimal settings have been determined, the patient can turn stimulation on and off with a small remote control. For example, some patients turn the generator off at bedtime.
Battery longevity varies depending on the parameter settings and numbers of hours the pulse generator is turned on each day. Estimated battery life is about found years at typical settings. When the pulse generator battery needs to be replaced, the old pulse generator is replaced by an entirely new one, and the extension and lead are not replaced so there is no further brain surgery involved. The replacement procedure can be done under local anesthesia.
It is important to keep in mind that currently, there is no cure for Parkinson’s disease. The goal of this surgery is to improve quality of life by minimizing some of the disabling symptoms of the disease. The effects of DBS are reversible. When the simulation is turned off, the symptoms will eventually reappear. On the other hand, the latest publications have demonstrated that the beneficial effects continue for years following surgery.
Recent studies have demonstrated that DBS may be effective in treating other conditions, such as Tourette’s syndrome, depression and obsessive-compulsive disorder. DBS has been used for many years to treat chronic pain not relieved by other treatments.