Deep Brain Stimulation

The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire under your skin connects this device to the electrodes in your brain.

Deep brain stimulation involves creating small holes in the skull to implant the electrodes, and surgery to implant the device that contains the batteries under the skin in the chest.

Exactly how DBS works is not completely understood, but many researchers and specialists believe that DBS regulates abnormal electrical signaling patterns in the brain.

In order to control normal movement and other functions, brain cells communicate with each other using electrical signals. In some movement disorders, these signals become irregular and uncoordinated which leads to motor symptoms.

DBS basically interrupts these unwanted signaling patterns in a way that allows the cells to communicate more smoothly and thereby lessens symptoms.

In the past, surgical approaches to movement disorders were irreversible and involved the destruction of brain tissue. In contrast, DBS is reversible because the electrodes can be removed. It also allows for greater flexibility during treatment because the generator can be adjusted, and even turned off if necessary.

Deep Brain Stimulation (DBS) is used at Semmes Murphey to treat a variety of issues including:

• Seizure disorders
• Epilepsy
• Chronic pain
• Tourette syndrome
• Essential tremor
• Dystonia
• Parkinson’s disease

It is also being studied to help patients with cluster headache, dementia, Huntington's disease, multiple sclerosis, and stroke recovery.

Semmes Murphey Clinic (SMC) is one of the leading deep brain stimulation implantation sites in the country and provides our patients with the highest levels of safety and experience.

Semmes Murphey physicians have specialized training in the use of intraoperative CT and MRI imaging to reduce operative time and improve the accuracy of placing DBS electrodes.

Deep brain stimulation is a serious and potentially risky procedure. Even if you might be eligible for deep brain stimulation, you and your doctors must carefully weigh the risks and potential benefits of the procedure.

The primary goal of DBS surgery is to help control symptoms and lead to a better quality of life.

Deep brain stimulation won't cure your disease, but it may help lessen your symptoms. If deep brain stimulation works, your symptoms will improve significantly, but they usually don't go away completely. In some cases, medications may still be needed for certain conditions.

Before surgery, you'll need medical tests to make sure that deep brain stimulation is a safe and appropriate option for you. You'll also need brain-imaging studies, such as an MRI to map the areas of your brain to implant the electrodes.

Deep brain stimulation isn't successful for everyone. There are a number of variables involved in the success of deep brain stimulation. And you may suffer from some side effects after the surgery.

Am I A Candidate for DBS?

You will want to discuss with your neurologist and care team to determine if you are a candidate for DBS. But the following conditions are a helpful guide:

• You have already tried a reasonable course of medications, as determined by a movement disorder neurologist
• You are significantly disabled by your disease
• You do not require routine MRI scans
• You are in reasonably good health
• You can take part in the programming of the device once implanted. (Give feedback during programming sessions and attend clinic visits)
• You have an adequate support network of family and friends

It's also important to talk with your doctor before surgery about what type of improvement you can expect for your condition.

Preparing for DBS Surgery:

• Stop taking any blood thinners such as Aspirin, Excedrin®, Ibuprofen, Aleve®, Advil®, and Motrin® 14 days before your surgery date
• Stop taking vitamins, fish oil, and herbal supplements 7 days before your surgery
• Shampoo and bathe with an antibacterial soap the night before and the morning of surgery to lessen the risk of infection
• Do not eat or drink after midnight on the evening before your surgery. You may drink only clear liquids up to four hours before the surgery. Clear liquids can include water, soda, coffee and tea (no creamer), clear broths, juices without pulp or solid material (apple juice), and popsicles
• On the morning of your surgery, take only the medicines that were approved during your pre-surgery visit. If you are on blood pressure medicine, be sure to talk to your surgeon about those medications

In general, here's how surgery for deep brain stimulation works:

Part 1: Brain Surgery:

For the brain surgery portion, your care team fits you with a special head frame to keep your head still during the procedure (stereotactic head frame). Then, team members use magnetic resonance imaging (MRI) to map your brain and identify where they'll place the electrodes.

Surgery can be done either under general anesthesia so that you'll be unconscious, or with you awake and alert. If you're awake for surgery, you'll be given a local anesthetic to numb your scalp before the procedure. Anesthetic isn’t necessary beyond the scalp because the brain has no pain receptors.

In certain cases, the use of intraoperative imaging enables fully asleep DBS surgery which eliminates the need to be awake for the procedure while delivering equivalent results.

Usually, a person remains awake during surgery so that he or she can answer questions and perform certain tasks to make sure that the electrodes are positioned correctly.

However, some medical centers now are using brain imaging to guide the electrodes to the right spot while a person is asleep. Each method has its pros and cons and may not be suitable for everyone or available everywhere.

The surgeon will implant one or two thin wire leads with a number of contacts (electrodes) at the tips into a specific area(s) of the brain. Then he or she will run a wire from the electrode(s) under your skin to a pulse generator (neurostimulator) implanted near your collarbone.

During surgery, both the neurologist and surgeon carefully monitor your brain to help ensure correct electrode placement.

Part 2: Chest wall surgery:

Next, the surgeon implants the part of the device that contains the batteries (pulse generator) under the skin in your chest, near your collarbone. It is similar to a cardiac pacemaker.

General anesthesia is used during this procedure. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated pulse generator.

The generator is programmed to send continuous electrical pulses to your brain. You control the generator, and you can turn it on or off using a special remote control.

Part 3: Activation:

A few weeks after the surgery, the device will be turned on and the process of finding the best settings for you begins. Some settings may cause side effects, but these often improve with further adjustments of your device.

The pulse generator in your chest is activated and programmed in your doctor's office using a special remote control. The amount of stimulation is customized to your condition. It may take as long as four to six months to find the optimal setting.

The times and amount of stimulation will depend on your condition. The stimulation may be constant, 24 hours a day, or your doctor may advise you to turn your pulse generator off at night and back on in the morning. You will have a special remote control at home to use to control your neurostimulator. In some cases, your doctor will program the pulse generator to let you make minor adjustments at home.

The battery life of your generator varies with usage and settings. When the battery needs to be replaced, your surgeon will replace the generator during an outpatient procedure.

Deep brain stimulation won't cure your disease, but it may help lessen your symptoms. If deep brain stimulation works, your symptoms will improve significantly, but they usually don't go away completely. In some cases, medications may still be needed for certain conditions.

Deep brain stimulation isn't successful for everyone. There are a number of variables involved in the success of deep brain stimulation. It's important to talk with your doctor before surgery about what type of improvement you can expect for your condition.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.