What Is Deep Brain Stimulation (DBS)?
Deep brain stimulation (DBS) is a treatment that uses a mild electrical current to affect how brain cells work. It requires a surgery to implant a device in the brain and chest that sends an electrical current through wires to specific brain areas causing problems.
How Does a Deep Brain Stimulator Work?
The deep brain stimulator has three parts:
- An electrical generator device: This device—similar to a heart pacemaker—is implanted underneath your collarbone. It sends continuous pulses of electrical current through wires attached to electrodes in the brain. This device is known as the implantable pulse generator (IPG).
- Electrodes: These thin wires (leads) deliver electrical impulses directly to the brain.
- Extension wires: These thin wires are insulated with a protective coating. They connect the electrodes to the electrical generator device.
The electrical current stimulates the brain’s nerve cells, interrupting abnormal signals in the brain that cause movement disorder symptoms.
What to Expect During DBS Surgery
The initial surgery for deep brain stimulation is an inpatient procedure to place the electrodes in the brain. Most patients go home the morning after surgery. A second short outpatient surgery seven to 10 days later places the electrical generator device and the extension wires.
Electrode Placement
To place the electrodes, your doctor:
- Gives you anesthesia to put you to sleep and keep you comfortable.
- Makes small incisions in the skin over the skull close to the target brain area.
- Makes one or two small holes in the skull and implants the electrodes.
- Uses an imaging system to scan during the procedure to make sure the electrodes are in the right place.
- Closes the incisions.
You may be awakened briefly during this procedure so your doctor can make sure the electrodes (leads) are placed in areas that improve your symptoms. You will not feel any pain during this part of the procedure.
Pulse Generator Placement
The second DBS surgery takes place under general anesthesia.
To place the pulse generator, your surgeon:
- Makes a small incision underneath your collarbone.
- Places leads (wires) under the skin and scalp to connect to the electrodes placed earlier.
- Implants the pulse generator under your collarbone.
- Connects the ends of the electrodes to the pulse generator using the extension wires.
- Closes the incision.
DBS Surgery Recovery
Most people spend one night in the hospital and go home the day after DBS implantation. Physical recovery takes several weeks, so resting as much as possible is important for healing. You will probably be able to return to work within two to four weeks.
About a month after the procedure, your neurologist will begin to program the stimulator over several visits. The goal is to fine-tune the pulse generator to the settings that reduce your symptoms and minimize side effects. Most people reach the right settings in about six months, but it can take up to 18 months to feel maximum benefit from the treatment.
What Are the Benefits and Risks of Deep Brain Stimulation?
DBS can help control symptoms that don’t respond to medications without causing serious side effects. Many people with DBS find they can return to activities that were previously difficult for them.
Although complications from deep brain stimulation surgery are rare, all surgeries come with some risks. Rare risks of DBS surgery include:
Other rare complications related to the DBS device may include problems with the device and leads, such as loose or disconnected wires or a malfunctioning pulse generator. Your doctor checks for these problems after surgery. If problems do happen, your doctor will perform a procedure to fix or replace the device, leads, or electrodes.
Side Effects of Deep Brain Stimulation
After the IPG is turned on and DBS treatment starts, some people experience side effects, including:
- Apathy
- Confusion, focus, or memory problems
- Changes in speech (problems with clarity, slurring, or word finding)
- Loss of balance
- Muscle cramping
- Numbness or tingling in the face or limbs (usually temporary)
- Visual problems, such as double vision (usually temporary)
Your doctor will work with you to minimize these possible side effects when adjusting your DBS settings.
Who Is Eligible for Deep Brain Stimulation?
People with medication-resistant movement disorders and other neurological and psychiatric conditions with widespread symptoms may be eligible for DBS.
Your doctor may recommend deep brain stimulation if you experience symptoms that interfere with your daily life. DBS may also help if your current medications aren’t controlling symptoms or cause unpleasant side effects.
Dystonia
DBS reduces abnormal posturing and sustained muscle contractions caused by dystonia. The DBS device uses electrical stimulation to disrupt excessive nerve signaling and reduce symptoms.
Drug-Resistant Epilepsy
DBS is recommended for people with epilepsy who do not respond well to two or more anti-seizure medications. DBS delivers customized programs of electrical stimulation to control and reduce seizure activity in the brain. It is often combined with anti-seizure medications for the best results.
Essential Tremor
DBS is the most common surgical procedure for essential tremor. It delivers electrical stimulation directly to a specific part of the thalamus, a structure in the brain that relays sensory and movement-related information to the brain. This electrical stimulation disrupts the brain signals that cause essential tremor.
Parkinson’s Disease
DBS surgery may be an option if Parkinson’s disease (PD) symptoms don’t respond well to medication or if the side effects of medication interfere with daily life. Electrical signals from the DBS device disrupt the electrical signals in the brain that are responsible for symptoms related to PD.
Obsessive-Compulsive Disorder
DBS can decrease symptoms of severe obsessive-compulsive disorder (OCD) that don’t respond to medication. Electrical stimulation from the DBS device targets a specific region of the brain called the ventral capsule/ventral striatum to help control OCD symptoms.
Current studies are investigating if DBS can help treat other conditions, including:
Why Choose Penn Medicine for Deep Brain Stimulation?
Penn Medicine is recognized as a national leader in delivering and advancing pioneering surgical treatments such as deep brain stimulation.
When you choose our team for DBS treatment, you’ll find:
- Personalized care: Our pre-operative DBS clinic team discusses each case at regularly scheduled meetings. This collaboration across disciplines ensures that every person receives individualized care designed to achieve the best outcomes.
- Extensive DBS expertise: We have performed thousands of DBS surgeries, making Penn one of the largest DBS treatment centers in the country.
- Excellent outcomes: Our surgical expertise reduces your risk of complications and promotes faster recovery times.
- Careful follow-up: After surgery, your neurologist programs the DBS device to address your specific needs. Routinely scheduled follow-up visits allow your doctor to adjust the device’s settings and your current medications to achieve the best possible results.
- Care close to home: Penn neurosurgeons see patients at satellite locations across the region, allowing for convenient consultations, second opinions, and pre- and post-operative care in your community.
Make an Appointment
Please call 800-789-7366 or make an appointment.