Deep Brain Stimulation (DBS)
Surgical Treatment for Essential Tremor and Parkinson's Disease
Deep brain stimulation (DBS) may enable patients suffering from some movement disorders and related symptoms to have greater control over their movements.
DBS is a surgical option for patients whose symptoms are helped but not sufficiently controlled by medications. Electrodes are implanted in the patient’s brain, at the precise location where nerve signals generate the tremors. These electrodes are then connected via an extension wire to a neurostimulator, which is implanted just under the skin below the patient’s collarbone.
The neurostimulator, also called an impulse generator or pacemaker, sends tiny electrical impulses through the wire into the brain to block the abnormal activity that causes the tremors. The amount of stimulation is programmed for the patient, and can be adjusted as their condition changes over time.
For many patients with Essential Tremor or Parkinson’s disease, deep brain stimulation treatment may offer the best hope for:
• restoring or maintaining the ability to perform activities of everyday life
• gaining more daily hours of symptom relief and good motor function
• increased independence
Deep brain stimulation is a multi-stage process that requires a commitment to ongoing follow-up care. The phases and timing will vary for each unique situation, but a typical process includes these steps:
Evaluation, diagnosis and screening - neurologists, neurosurgeons and other experts examine the patient and use diagnostic tests to confirm the diagnosis and whether the patient is a good candidate for deep brain stimulation.
Surgery to implant the leads, neurostimulator and extensions - One or two leads, each with four 1.5 millimeter electrodes, are implanted into the patient’s brain. The neurosurgeon will also implant one or two pace-maker-like devices, called a neurostimulator, under the collarbone. Wires are placed under the skin that run behind the ears and down the neck, to connect the neurostimulator(s) with the leads.
Initial programming of the implanted neurostimulator - The system is left off until this session. A neurologist uses a programming device that sends wireless signals to turn on and adjust the system. Initial programming may take several sessions, to get the optimum symptom control for the patient.
Programing sessions to adjust neurostimulator - DBS patients will have a lifelong relationship with their neurologist, who will periodically perform noninvasive “tuning” to ensure the best control of symptoms as a patient's condition changes over time.
Periodic battery replacement - Minor surgery is required to replace the neurostimulator batteries every three to six years, depending on use.
Safe and Effective
Approved by the FDA in 1997, deep brain stimulation inactivates, but does not destroy, the parts of the brain responsible for the shaking. This is an improvement over alternative treatments, called thalamotomy and pallidotomy that surgically destroy tiny parts of the brain, and has been shown to be equally effective.
DBS is not a cure for Parkinson's. Though the surgery can help improve patients' movement, DBS does nothing for non-motor symptoms of the disease, such as depression, anxiety, balance problems, cognitive decline and memory loss. In some cases, the procedure can make these issues worse; in others, it can cause problems where there were none. In all cases, patients need sustained medical care after surgery, as their disease continues to progress.
Patients typically go home 1-2 days after the surgery.
Mehmet Caglar Berk, MD
Richard Rosenbaum, M.D.Brooke Walters, M.D.
For more information, please contact:
Portland Parkinson’s Program in collaboration with the Oregon Clinic
1600 NE Broadway
Portland, OR 97232