Deep Brain Stimulation Questions and Answers

Deep brain stimulation, or DBS, uses a surgical implant to modulate abnormal circuitry of the brain.  It can provide tremendous help to patients with Parkinson’s disease, essential tremor, dystonia and epilepsy.

Think of it as a pacemaker for the brain. A small device is implanted below the collarbone, and tiny electrodes run through the body to the brain. Neurosurgeons at Norton Neuroscience Institute place the electrodes in the brain at the precise spot that’s known to provide relief from abnormal movements.

Low-voltage electrical pulses travel from the device in the chest, through wires inside the body, and change signals in the parts of the brain that are abnormal in patients with Parkinson’s disease or essential tremor.

Deep brain stimulation was approved by the Food and Drug Administration for essential tremor in 1996, and for Parkinson’s disease in 2001. The benefits for abnormal movements can last decades or longer.

Your nervous system, including the brain, works like an electrical circuit that is wired throughout your body. If a circuit becomes faulty and triggers abnormal signals, you can experience symptoms like tremors anywhere along the circuit: hands, legs, neck, etc.

Researchers aren’t sure why yet, but deep brain stimulation can help alter faulty circuits. Improving the signals that travel through the nervous system can improve symptoms.

The gentle electrical pulses of deep brain stimulation alter the signals that cause symptoms like tremors.

The surgery itself to implant the electrodes takes a few hours. Implantation is done in two stages. During the first sage, the electrodes are placed in your brain, and you’ll spend that night in the hospital. During the second stage, the internal pulse generator (which is the computer and battery) is implanted under the skin of the  chest, and you’ll usually go home the same day.

You’ll have appointments prior to surgery to establish where the electrodes will be placed and to map your brain for the day of the surgery. After surgery, follow-up visits will focus on programming the stimulator.

Generally, deep brain stimulation is covered by Medicare for essential tremor and Parkinsonian tremor. You have to qualify under Medicare standards.

Other insurers often cover deep brain stimulation with pre-authorization.

If you’ve been taking levodopa for Parkinson’s disease with success, deep brain stimulation is a supplement to, but not a substitute for, medication.

Symptoms that deep brain stimulation helps include:

  • Tremors — whether resting or action tremors in the hands. Deep brain stimulation has been shown to be more effective for tremors than levodopa.
  • Slow movement (bradykinesia)
  • Rigid muscles
  • Levodopa side effects such as random, uncontrolled movements (dyskinesia)

Deep brain stimulation does not help with nonmotor symptoms such as constipation, memory, cognitive issues, depression, anxiety, swallowing difficulty or issues with walking or balance. Deep brain stimulation actually may worsen these symptoms. It won’t help with secondary parkinsonian disease symptoms such as those in multiple system atrophy, progressive supranuclear palsy and vascular parkinsonism.

That used to be the case. Patients would have to move their limbs as instructed by the neurosurgeon so the right spot for the electrodes could be identified.

Norton Neuroscience Institute was first in Louisville to perform the surgery routinely while the patient is asleep. In addition to being more comfortable for the patient, placing the electrodes while the patient is unconscious allows for a shorter surgery, which reduces risk.

With the surgeon’s ability to image the brain with high resolution, the electrodes’ locations can be planned ahead of time without the need for patient interaction during surgery.

It doesn’t cure Parkinson’s disease and other movement disorders, but it can lessen the symptoms. For many patients, it transforms their lives and allows for improvements in quality of life, such as improved socialization, mobility and self-care.

The stimulation works 24/7 and allows many patients to rely less on medication. If other treatments become available, your doctor still can consider those for you.

If your medication no longer works well to control your symptoms or you have bothersome medication side effects, you could be a candidate. Your neurologist and neurosurgeon will also consider these factors:

  • Medication, especially levodopa, had improved your Parkinson’s disease symptoms.
  • Your Parkinson’s disease medications cause severe side effects.
  • You need more frequent or higher doses of your medication to get symptom relief.

Deep brain stimulation isn’t a last-resort treatment. Recently diagnosed patients can benefit from deep brain stimulation.

Talk to your neurologist about your options or contact the Norton Neuroscience Institute movement disorders team.

The implantation of the electrodes is much like the process for Parkinson’s disease. Deep brain stimulation can help reduce the severity of essential tremor and help you regain the ability to do day-to-day tasks.

Performing the brain surgery while the patient is anesthetized and unconscious is faster and safer. Patients also can take their medication prior to surgery.

Conventional deep brain stimulation required patients to respond to the neurosurgeon’s instructions to help place the electrodes properly. Your neurosurgeon now can plan ahead of time where to place the electrodes, using high-resolution scans that map the brain.

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