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Deep Brain Stimulation Overview

X-ray shows the DBS wires implanted in the brain and the wires leading down toward the pulse generator in the chest.

Deep brain stimulation (DBS) is a surgical treatment for several medical conditions including Parkinson’s disease (PD), tremor and dystonia. The evaluation involves a thorough screening process followed by the surgical implantation of a hardware system that delivers continuous electrical impulses to specific areas deep in the brain. DBS was FDA approved for tremor in 1997, Parkinson’s disease in 2002, dystonia in 2003 and obsessive-compulsive disorder in 2009. DBS is a unique neurosurgical procedure in that the therapy does not damage the brain regions and the implanted hardware can be removed if necessary.

The implanted hardware delivers constant electrical stimulus to the regions of the brain impacted by the loss of dopamine nerve cells. The exact mechanism of how DBS works is still unknown. The x-rays show the implanted wires in the brain are connected to the pulse generators (also called batteries) in the upper chest. More than 40,000 individuals have DBS worldwide. In the hands of experts, DBS is an effective therapy that continues to improve symptoms for over 10 years and has little to no side effects when properly adjusted.

When is the right time for DBS?

Parkinson’s disease: Medications that treat the movement symptoms of PD can be effective for many years; however, over time, many individuals may experience a “wearing off” effect where the medication seems to lose potency during the day. Some individuals may also experience dyskinesia or involuntary or uncontrollable movements. Deep brain stimulation can minimize or eliminate the “wearing off” effect and dyskinesia in some individuals and also provide relief for tremor, stiffness, slowness and some walking problems. Every individual with PD has their own unique experience with PD so a thorough screening evaluation provides information for the medical provider, patient and family about what to expect from DBS. DBS is not a treatment for gait freezing, falls or speech problems. Symptoms that do not respond well to PD medication typically do not respond to DBS, except for tremor.

DBS wires from the brain connect to the electrical pulse generators in the upper chest.

Tremor: DBS is an appropriate treatment option for individuals with tremor when medications are not effective enough to reduce the tremor or when medication side effects are intolerable. Like PD, individuals with tremor have their own unique symptoms associated with tremor and a thorough screening evaluation is important to provide information about what to expect from DBS.

Dystonia: Dystonia is a complex condition that can affects different parts to the body. The type of dystonia can be predictive of how much benefit DBS may offer. The response to DBS varies widely with certain types of dystonia respond exceptionally well; the response can vary depending on several factors related to the symptoms, time of onset and progression. The screening process should be conducted by medical teams that are experienced in both DBS and dystonia that are involved with the long term care of individuals living with dystonia and DBS.

Am I a good candidate for DBS?

Individuals with PD that might be good candidates for DBS can answer “yes” to the following statements:

  •  Levodopa still helps reduce the symptoms of Parkinson disease
  • My medicine doesn’t last from dose to dose or wear off before next dose
  • My medicine still works but isn’t controlling my tremor
  • Dyskinesia is limiting my activities, is bothersome or causing pain
  • My thinking functions are good and I am not having hallucinations
  • Anxiety and/or depression is not disrupting my life or bothersome
  • I can live with an implanted device in my brain or body
  • My family is supportive and I can travel for DBS appointments as necessary
  • I have access to DBS experts for a thorough evaluation and care
  • I understand what is involved to have the surgery
  • My general health is good

Individuals with tremor and or dystonia that might be good candidates for DBS can answer “yes” to the following statements:

  • I have tried the typical medications
  • I have symptoms that interrupt my activities or are bothersome
  • My mood is not anxious or depressed
  • My thinking functions are good
  • I can live with an implanted device in my body
  • My family is supportive and I can travel to the DBS appointments as necessary
  • I have access to DBS experts for a thorough evaluation and care
  • I understand what is involved to have the surgery
  • My general  health is good

What is the evaluation process for DBS?

Patients are evaluated by a neurologist specialized in movement disorders to confirm the diagnosis. If medication options are limited and you are interested in DBS, you will be scheduled for medication testing, a neuropsychological evaluation and a DBS overview education and counseling appointment. There may be other appointments as needed depending on your individual circumstances.

Medication Testing: Medication testing essential prior to DBS. This testing is indicated for all individuals with PD. The steps for medication testing include an examination first thing in the morning before taking any PD medications. This exam includes a measurement of slowness, stiffness, tremor, dexterity, walking, balance and speech. The mood is also noted while in the off state. The person then takes their morning dose of PD medications. After the medications are working well, you are re-examined and this time the examiner is also measuring the severity of dyskinesia or involuntary movements if any. This appointment usually takes 60-90 minutes, depending on the response to medication.

Neuropsychological | Psychiatry Evaluation:  Neuropsychological testing is required to assess for any significant thinking related problems exist that may increase your surgical risks. The neuropsychologist also asks about impulse control problems, anxiety and depression.

DBS Education and Counseling: The counseling appointment is important to review your expectations for surgery, review your general health, medications, support network, and occupational and medication safety issues related to DBS. A review of the surgical procedure, risks and complications and long term care requirements are discussed. The appointment also focuses on what to expect after surgery for recovery and timeline for symptom improvement. We also discuss the implanted battery options, hardware and other issues related to the device. It is very important that patients understand how the stimulator will affect their symptoms before considering DBS surgery. As a rule in Parkinson’s disease, a properly placed stimulator will mimic the patients best On state that results from an optimal medication regimen.

Once you are cleared to proceed with DBS, you will have an evaluation by a neurosurgeon that specializes in DBS surgery.

Neurosurgery Consult: We facilitate the referral to the neurosurgeon and provide our evaluation results to the neurosurgeon prior to your consultation. The neurosurgical consultation will include more examinations or testing, typical blood analysis and a brain MRI. The neurosurgeon will go into more details about the procedure, risks and complication rates. Before surgery, you should see your primary care physician for a check-up on your general health.

Learn about our comprehensive DBS services that includes evaluation, management and troubleshooting unsatisfactory results.

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