Doctor exams brain scan

Deep Brain Stimulation (DBS)

Sometimes, due to advanced Parkinson’s disease, essential tremors, multiple sclerosis or dystonia, the brain’s signals fire irregularly and cause involuntary movement and shaking throughout the body. 

We understand how these diseases can affect even the most routine aspects of daily life. If you suffer from movement related symptoms, consider deep brain stimulation (DBS). 

DBS is a procedure that works by placing thin electrodes in areas of the brain affected by neurological disorders. Those electrodes then send electrical pulses to normalize or eliminate irregular brain signals, helping manage the movement symptoms affecting you. It is commonly compared to a pacemaker for the brain.

DBS provides essential treatment for patients whose medication just isn’t working anymore. Using DBS in combination with an optimized medication regimen can have a transformative effect on a patients’ quality of life because the electrodes remain active in between doses of medication. 

For over 30 years, the DBS procedure has been improved upon by Providence surgeons with leading-edge research and technology. Our nationally recognized neuropsychologists are now using DBS in experimental clinical trials to treat major depression, addiction, ADHD and dementia.

DBS helps control many symptoms of Parkinson's disease, including shaking, slowed movement, and stiffness. DBS often provides several additional hours of movement control per day when compared to medication alone. You and your neurologist should discuss the role of DBS in your long-term treatment plan early after your diagnosis with Parkinson’s disease.

Patients become candidates for DBS once medication alone does not effectively control their symptoms. The best time to maximize benefit from DBS is when medications alone aren't providing enough relief, but still have some effect. Examples include:

  • Movement symptoms like tremor and stiffness are occurring for more hours each day
  • Medication doses take longer to work, and/or the effect is less predictable
  • The medications' effects wear off between doses
  • You have to take medications more often, including during the night
  • You need higher doses of medications to get the same effect
  • Side effects of your medications are becoming more problematic

You may be a candidate for DBS surgery if you have essential tremor in at least one arm or hand and it keeps you from doing what you want to do. This can include daily tasks like writing,  eating or social interactions. 

DBS tends to be the most effective for upper extremity (arm or hand) tremors, but can improve tremor in the head, voice and legs in certain situations.

If you have tried medications and they didn’t work, or you could not tolerate the side effects of the medications, then you should discuss DBS with your doctor. The best time to maximize benefits from DBS is when your tremor becomes disabling despite optimized medical therapy directed by a neurologist.

DBS helps control the symptoms of dystonia, a neurological movement disorder characterized by involuntary muscle contractions. These contractions force certain parts of the body into repetitive, twisting movements or painful postures. Dystonia can cause severe involuntary muscle contractions that may interfere often with everyday functions like walking, sleeping, eating, and talking.

DBS is a treatment option for most forms of dystonia, except for most cases of secondary dystonia, which is when dystonia is a result of another health condition, injury or infection. Dystonia may get worse over time. The best time to maximize benefit from DBS is when your dystonia becomes disabling despite optimized medical therapy directed by a neurologist.

Note: DBS for dystonia is classified as a Humanitarian Device - Authorized by Federal Law as an aid in the management of chronic, intractable (drug refractory) primary dystonia, including generalized and/or segmental dystonia, hemidystonia, and cervical dystonia (torticollis), in patients seven years of age or above. The effectiveness of the devices for treating these conditions has not been demonstrated.

Your neurological team will conduct an MRI prior to surgery to precisely identify placement of DBS electrode (lead) implantation into specific areas of the brain. During the operation, your surgeon will use minimally invasive techniques to insert a neurostimulator (similar to a pacemaker) under the skin of the neck or chest.  The neurostimulator in the chest is connected to the lead in the brain by an extension cable, which runs under the skin of the neck. Your surgeon will also place a small pulse generator under your collarbone to help regulate the strength of the impulses.

We provide a customized, frameless approach to your DBS surgery. It employs a custom-made mini-frame that allows the patient more freedom of movement during the procedure. This ensures that you are as comfortable as possible while reducing surgery time. It allows us to optimize your recovery without compromising the precision of the procedure. 

Possible complications and side effects

Thanks to our advanced research in neurological procedures, patients experience better long-term outcomes post-operation with minimal side effects. Still, some risks and complications may arise. For DBS surgery, these complications may include brain hemorrhaging, stroke and seizures. Because the surgery involves stimulating the brain, you may experience numbness or tingling, muscle tightness and unwanted mood changes. 

A few weeks following your surgery, your neurologist will begin to adjust your DBS settings to best control your symptoms and minimizing side effects. It will take a few programming sessions to find the stimulation levels that work best for you. You will have more frequent follow-up visits for the first few months to check your results and adjust as needed. These appointments are key to getting the results you want over time.

You can typically return to all of your usual activities, always following your doctor's guidance regarding any specific limitations after surgery. DBS has little impact on your daily activities, the clothes you can wear, or how you travel. DBS delivers therapy 24 hours a day, so it's working to control your symptoms when you wake up first thing in the morning. DBS doesn’t require any maintenance from you (except for recharging if you have a rechargeable system).

You will continue to have regular checkups with the neurologist who manages your DBS therapy, similar to before surgery. Your neurologist will make sure that your DBS system is working properly, adjust your stimulation to best control your symptoms and check the battery of your neurostimulator to determine when you will need a replacement.

Doctors Specializing in Deep Brain Stimulation (DBS)

At Providence, you'll have access to a vast network of dedicated and compassionate providers who offer personalized care by focusing on treatment, prevention and health education.