Deep Brain Stimulation

Deep brain stimulation is used to treat certain medical conditions that do not respond to conventional medical treatments. An electric current is sent to an area of the brain that is causing problems. A device that generates this electric current sends it in pulses to a specific area deep inside the brain.

Deep brain stimulation has been used to treat several medical conditions. It was first used to treat pain when medicines and other traditional therapies did not work. More recently, it has been used to treat people with medicine-resistant movement disorders, including Parkinson's disease, essential tremor, epilepsy, rare inherited disorders of muscle movement (dystonias), cluster headaches, and multiple sclerosis. Deep brain stimulation is also being used to treat cases of obsessive-compulsive disorder and depression that fail to respond to conventional treatments, such as medicine and shock therapy (electroconvulsive therapy).

Deep brain stimulation is a safe and convenient treatment. It can be used 24 hours per day. The intensity and frequency of the pulses can be adjusted. It can be easily discontinued at any time. Medicines and other treatments can be used at the same time as deep brain stimulation. Generally, deep brain stimulation can be used without causing permanent damage to brain tissue.

The deep brain stimulation device has 3 parts:

  • A lead. This is a thin wire. It goes through a small opening in the skull. It delivers the electric pulse.

  • A power source. This is called the neurotransmitter. It is usually placed under the skin in the upper part of the chest, similar to how a heart pacemaker is inserted. It is powered by a long-lasting battery.

  • An extension. This is a wire that connects the lead to the power source. The extension is passed under the skin of the head and neck and down to the power source.

The electric pulses are automatic. The timing is set before the device is placed in the body. A computer can send a radio signal to the neurotransmitter if the frequency of the pulse needs to be adjusted. A hand-held controller can be used to turn the neurotransmitter off. This is done if side effects of treatment are bad or if battery power needs to be conserved.

PROCEDURE

The surgery to insert a deep brain stimulation device is done in 2 parts:

  • The lead is inserted:

  • Numbing medicine (local anesthetic) is injected into your scalp. You are awake but feel no pain.

  • A small hole is made in your skull.

  • A computer is used to make a map of your brain. This shows the part of the brain that needs to be treated.

  • Your caregiver will ask you various questions. This helps the surgeon find the most appropriate part of the brain to place the lead.

  • The neurotransmitter and extension wire are inserted:

  • Medicine to make you go to sleep (general anesthetic) is used for this part of the procedure.

  • A small opening is made in the skin behind your ear. The extension wire is inserted through this opening.

  • A second opening is made in the upper part of your chest. This is for the neurotransmitter.

RISKS AND COMPLICATIONS

The procedure to insert a deep brain stimulation device is generally safe. However, as with all surgical procedures, there are some risks. These risks may be greater for the following people:

  • People older than 70 years.

  • People with blood vessel disease.

  • People receiving antiplatelet or anticoagulant therapy.

  • People with unstable medical conditions, such as severe coronary artery disease, severe hypertension, uncontrolled diabetes, previous stroke, heart failure, and severe dementia.

If complications occur, they are usually temporary. They may include bleeding, leaking of fluid from around the brain, and infection.

Possible side effects from insertion of the device include:

  • Temporary tingling in the face, arms, or legs.

  • Pain or swelling in the areas where the wires are placed.

  • An allergic reaction to parts of the device.

  • Slight problems with vision or speech.

  • Slight problem with balance.

  • Slight loss of movement.

  • Some jolting or shocking sensations.

HOME CARE INSTRUCTIONS

  • Understand how to operate the device. Be sure to ask whether it is okay to turn it off at night.

  • Ask if there are any times or places when the device should not be turned on. Electrical devices at home will not affect the device. This includes microwaves and computers.

  • Continue to take any medicine prescribed by your caregiver. Do not start taking any new medicine unless your caregiver says it is okay. This includes over-the-counter medicines.

  • Keep all follow-up appointments. The device will need to be checked periodically by your caregiver. Batteries usually last for 3 to 5 years.

FOR MORE INFORMATION

American Association of Neurological Surgeons: www.aans.org