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Deep brain stimulation

Globus pallidus deep brain stimulation; Subthalamic deep brain stimulation; Thalamic deep brain stimulation; DBS; Brain neurostimulation

Deep brain stimulation (DBS) uses a device called a neurostimulator to deliver electrical signals to the areas of the brain that control movement, pain, mood, weight, obsessive-compulsive thoughts, and awakening from a coma.

Description

The DBS system consist of four parts:

Surgery is done to place each part of the neurostimulator system. In adults, the whole system can be placed in 1 or 2 stages (two separate surgeries).

Stage 1 is usually done under local anesthesia, meaning you are awake, but pain-free. (In children, general anesthesia is given.)

Stage 2 is done under general anesthesia, meaning you are asleep and pain-free. The timing of this stage of surgery depends on where in the brain the stimulator will be placed.

Once connected, electric pulses travel from the neurostimulator, along the extension wire, to the lead, and into the brain. These tiny pulses interfere with and block the electrical signals that cause symptoms of certain diseases.

Why the Procedure Is Performed

DBS is commonly done for people with Parkinson disease when the symptoms cannot be controlled by medicines. DBS does not cure Parkinson disease, but can help reduce symptoms such as:

DBS may also be used to treat the following conditions:

Risks

DBS is considered safe and effective when done in the right people.

Risks of DBS placement may include:

Problems may also occur if parts of the DBS system break or move. These include:

Possible risks of any brain surgery are:

Risks of general anesthesia are:

Before the Procedure

You will have a complete physical exam.

Your doctor will order many laboratory and imaging tests, including a CT or MRI scan. These imaging tests are done to help the surgeon pinpoint the exact part of the brain responsible for the symptoms. The images are used to help the surgeon place the lead in the brain during surgery.

You might have to see more than one specialist, such as a neurologist, neurosurgeon, or psychologist, to make sure that the procedure is right for you and has the best chance of success.

Before surgery, tell your surgeon:

During the days before the surgery:

The night before and on the day of surgery, follow instructions about:

After the Procedure

You may need to stay in the hospital for about 3 days.

The doctor may prescribe antibiotics to prevent infection.

You will return to your doctor's office at a later date after surgery. During this visit, the stimulator is turned on and the amount of stimulation is adjusted. Surgery is not needed. This process is also called programming.

Contact your doctor if you develop any of the following after DBS surgery:

Outlook (Prognosis)

People who have DBS usually do well during the surgery. Many people have great improvement in their symptoms and quality of life. Most people still need to take medicine, but at a lower dosage.

This surgery, and surgery in general, is riskier in people over age 70 and those with health conditions such as high blood pressure and diseases that affect blood vessels in the brain. You and your doctor should carefully weigh the benefits of this surgery against the risks.

The DBS procedure can be reversed, if needed.

References

Johnson LA, Vitek JL. Deep brain stimulation: mechanisms of action. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 91.

Lozano AM, Lipsman N, Bergman H, et al. Deep brain stimulation: current challenges and future directions. Nat Rev Neurol. 2019;15(3):148-160. PMID: 30683913 pubmed.ncbi.nlm.nih.gov/30683913/.

Rundle-Gonzalez V, Peng-Chen Z, Kumar A, Okun MS. Deep brain stimulation. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 37.

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Review Date: 9/21/2019  

Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Surgery, Johnson City Medical Center, TN; St-Alexius Medical Center, Bismarck ND; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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