What is deep brain stimulation (dbs)?

Deep brain stimulation (DBS) uses electrical pulses to stimulate an area of the brain. This can change the activity in that area of the brain. You may need two surgeries to implant the devices that stimulate the brain.

Most often, DBS is used to relieve symptoms of Parkinson's disease when they can't be controlled by medicines. But it can also be used for other conditions, such as multiple sclerosis and obsessive-compulsive disorder.

The devices are often put in during separate surgeries on different days. During one surgery, your doctor will drill small holes in your skull to place the tiny wire electrodes in your brain. Your scalp will be numb, and you won't feel any pain. During the other surgery, the doctor puts in a small, battery-powered generator. It's placed under the skin of your chest near your collarbone. This device is then connected to the electrodes in your brain.

DBS may be used to relieve symptoms of Parkinson's disease, especially tremor, when they can't be controlled with medicine. It's the surgical treatment of choice for Parkinson's disease. That's because it works better, is safer, and is less harmful to brain tissue than other surgical methods.

DBS of the thalamus is done to treat both disabling tremor caused by Parkinson's disease and essential tremor.

Procedures that stimulate parts of the brain called the subthalamic nucleus and the globus pallidus are done to help control a wider range of symptoms (along with tremor). They are used more often than stimulation of the thalamus. Symptoms that are most often helped (besides tremor) include problems with changes between "on" and "off" time and dyskinesia. "On" time is when medicine taken for Parkinson's is helping your symptoms. Symptoms that are less likely to get better include problems with walking, balance, and speech. In some cases, DBS can make these problems worse.

DBS may also be used to treat severe tremor related to multiple sclerosis (MS). It usually is a last resort after all other options have been tried without success to treat MS tremor. Only people with severe tremor are candidates.

Compared to only taking medicine for Parkinson's disease, having DBS of either the subthalamic nucleus (STN) or globus pallidus (GPi) along with taking medicine gave people almost 5 more hours of "on" time on average each day. "On" time is when medicine taken for Parkinson's is helping your symptoms.

DBS of the thalamus only works to reduce tremor. It does not affect other motor symptoms.

Two studies compared DBS of the STN to DBS of the GPi. The studies showed similar reductions of motor symptoms of Parkinson's disease after 1 and 2 years.

• The group that had DBS of the STN was able to take less medicine for Parkinson's disease after 2 or 3 years compared to the group that had DBS of the GPi.
• Quality of life was similar between the two groups.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired.
• Be active. Walking is a good choice.
• For 4 to 6 weeks:
  • Avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum and mopping floors. It also includes swimming, or swinging a golf club or tennis racquet.
  • Do not raise your arm (the one on the side of your body where the pulse generator is located) above your shoulder.
  • Allow your body to heal. Don't move quickly or lift anything heavy until you are feeling better.
• Many people are able to return to work within 1 to 2 weeks after surgery.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines or about taking the same medicines in a new way.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Keep the incision dry while it heals. Your doctor may recommend sponge baths for about 7 days, but don't get the incision wet. Your doctor will let you know when you may take showers. After a shower, pat the incision dry.
• Don't use hydrogen peroxide or alcohol on the incision. They can slow healing. You may cover the area with a gauze bandage if it oozes fluid or rubs against clothing. Change the bandage every day.
• Don't take a bath or get into a hot tub for the first 2 weeks, or until your doctor tells you it is okay.

Ice

• If the area feels sore or tender, put ice or a cold pack on it for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.