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. Your doctor will drill small holes in your skull. Then tiny wire electrodes are placed in your brain. You may or may not be awake during the surgery. If you're awake, you will help the doctor know where to place the electrodes where they will work best. If you're not awake, your doctor might use a type of imaging (MRI) to help place the electrodes.

It may seem scary to be awake during this surgery. But your scalp will be numb. You won't feel any pain. You will stay in the hospital for a day or two after this surgery.

The other step is to put in a small, battery-powered generator. It's placed under the skin of your chest near your collarbone. This device is connected to the electrodes in your brain. To do this, the doctor will use a small wire that runs under your scalp and skin. You won't be awake for this surgery.

After the surgery, you will have a short hospital stay. Your doctor may wait for you to heal before turning on the generator.

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.

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.

Risks of DBS include:

• Infection or skin irritation caused by the device in the chest (stimulator) or by the wires or electrodes.
• Bleeding in the brain during the surgery, resulting in a stroke.
• Numbness, tingling, twitching, or other abnormal sensations when the device is turned on. (These usually don't last long and can be stopped by adjusting the programming of the deep brain stimulation device.)
• Problems with the device, such as:
  • A break in the wire leading from the electrode to the stimulator.
  • Movement of the wires or the device under the skin.
  • Need for a new battery for the device. A battery typically will last about 5 years.
  • Failure or malfunction of the stimulator or the electrodes.
• Psychological problems, such as apathy and depression.
• Problems with thinking, memory, speech, or swallowing.
• Trouble with walking or balance and an increased risk of falling.
• Seizures.

You will stay in the hospital for several days after the procedure while your doctor checks the effect of DBS.

During your surgery, the doctor implanted electrodes in your brain and a pulse generator under the skin of your chest. Then the doctor connected the electrodes to the generator. This was done with a wire running under the skin of your head, neck, and shoulder.

You will probably have to stay in the hospital for a day or two after surgery. You may have some soreness where your skin was cut.

After you go home, you will likely have to go back to the doctor a number of times. The doctor will adjust the system so that it works best for your symptoms.

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.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• Your head will be secured in a metal frame to keep it still during surgery. You may have an imaging test (MRI) while your head is in the frame. It helps the doctor find the right area of your brain.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 3 to 4 hours.