Deep Brain Stimulation

Deep brain stimulation (DBS) is used to treat a number of movement disorders including essential tremor. DBS is a way to inactivate the thalamus, a structure deep in the brain thought to be responsible for the tremor, without purposefully destroying parts of the brain.

DBS is preferred over thalamotomy (a surgical operation that permanently alters areas of the thalamus). Experts donít know how DBS suppresses tremors, but it may suppress them by disrupting the nerve activity. The treatment of DBS is as effective as thalamotomy.

How does it work?
To treat essential tremor, electrodes are placed in the thalamus. The electrodes are connected by wires to an impulse generator (IPG), which is a type of pacemaker device that is implanted under the skin of the chest, below the collarbone. Once activated, the device sends continuous, painless electrical pulses to the thalamus in order to block impulses that cause tremors. This treatment has the same effect as thalamotomy without actually destroying parts of the brain.

The IPG can easily be programmed using a computer that sends radio signals to the IPG. Patients are given special device so they can externally turn the IPG on or off.

Depending on use, the stimulators can last three to five years. IPG replacement procedure is relatively simple.

How effective is deep brain stimulation?
DBS provides moderate relief for approximately 90 percent of patients.

What are the pros and cons of deep brain stimulation?
Some advantages of deep brain stimulation:

Some disadvantages of deep brain stimulation:

Who should consider DBS?
There are many important issues to be addressed when considering deep brain stimulation. These issues should be discussed with a movement disorders expert or a specially trained neurologist.

A person considering DBS should have had an adequate trial of medications. Surgery is not recommended if medications can adequately control the disease. However, surgery should be considered for people who do not achieve satisfactory control with medications or experience major side effects. Talk to your doctor to find out if DBS is right for you.

What happens during the procedure?
Surgeons locate target areas of the brain on which they will place electrodes. Most surgeons locate these areas with the help of CT (Computed Tomography) or MRI (Magnetic Resonance Imaging), but some surgeons use an electrode recording technique to map and target the specific areas that they will need to reach.

Once the correct locations are identified, permanent electrodes are implanted. The loose ends are placed underneath the skin of the head and any incisions are closed with sutures. One week later, the patient is re-admitted to the hospital for a very brief time. Once the patient is placed under general anesthesia, doctors disconnect wires from the loose ends of the electrodes and connect those wires to impulse generators. Two to four weeks later, the IPG is turned on and adjusted. It may take a few weeks after the simulators and medications are adjusted before patients experience adequate symptom relief. However, DBS causes very few side effects.

What are the risks?
As with any surgical procedure, there are risks. There is a two- to three-percent risk of a serious and permanent complication such as paralysis; changes in thinking, memory, and personality; seizures; and infection. In some patients speech changes can also occur. Talk to your doctor to determine if these risks apply to you.

Will I be asleep during the procedure?
Throughout most of the procedure you will remain awake. This allows the surgical team to interact with you when testing the effects of the stimulation. Small amounts of local anesthetic (pain-relieving medication) are given in sensitive areas. Most people experience minimal discomfort during the procedure.

What should I expect after DBS?
You may feel tired and sore, but you will be given medication and kept comfortable. Also, you may have irritation or soreness around the stitches and pin sites.

As with any surgery, there are some guidelines and limitations that you should follow after DBS. Be sure to discuss these topics with your doctor and ask questions before surgery. Understanding what you will experience and knowing what to expect afterward can help ease some of the natural anxiety that comes with any medical procedure.

When will I be able to go home?
The average hospital stay for DBS surgery is two to three days.

How should I care for the surgical area once I am home?

Will I have to limit my activity following DBS?

Warning:
Call your doctor immediately if you experience any of the following symptoms:

Can I use electrical devices?
While you should be able to use most electronic devices, you should be aware that:

© Copyright 1995-2006 The Cleveland Clinic Foundation. All rights reserved

 

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 6/24/2004

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