What is deep brain stimulation (DBS)?

Deep brain stimulation is a treatment for movement difficulties, such as muscle tremors, muscle stiffness, and slowed movement. Deep brain stimulation treats movement difficulties caused by neurological conditions, such as Parkinson’s disease, essential tremor, and dystonia.

Movement difficulties occur when the brain sends out faulty electrical signals to the muscles. Deep brain stimulation uses electrical impulses to block faulty signals and improve movement problems.

Your brain functions like an electrical circuit board. Different areas of the brain control different activities and functions, such as emotions, thoughts, sensations, and muscle movement. All activities and functions are the result of electrical signals that pass through cells called neurons. Malfunction of these electrical signals can make your muscles contract too quickly, too slowly, or not at all. Deep brain stimulation stops faulty electrical signals from passing through neurons. 

Deep brain stimulation is only one method used to treat movement problems and disorders. Discuss all of your treatment options with your doctor to understand which options are right for you.  

Types of deep brain stimulation devices 

Deep brain stimulation involves surgical placement of three devices into your body. The devices include:

  • Lead (electrode), a wire with an electrode that is placed in the specific area of your brain that is sending faulty signals to your muscles 
  • Neurostimulator (internal pulse generator, or IPG), a small battery-operated computer designed to send electrical impulses to your lead
  • Extension, an insulated wire that connects the lead to the neurostimulator

All deep brain stimulation devices are removable if they cause allergic reactions, if they are not effective, or if better treatments are developed for your condition.

Why is deep brain stimulation (DBS) performed?

Your doctor may recommend deep brain stimulation to treat movement problems. Problems include involuntary muscle contractions, stiffness, difficulty walking, and tremors caused by certain neurological conditions. These conditions include:

  • Parkinson’s disease, a degenerative brain disorder that leads to uncontrollable shaking, muscle stiffness, and severe problems with coordination and balance
  • Essential tremor, a neurological condition that causes trembling back-and-forth movements of the hands, head, arms, legs, torso and voice
  • Dystonia, a movement disorder that causes involuntary muscle spasms and contractions throughout the body leading to movements such as contorting, pulling and twisting

Your doctor may only consider deep brain stimulation for you if other treatment options with less risk of complications, such as medications, have failed to prevent or lessen movement problems. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on deep brain stimulation.

Who performs deep brain stimulation (DBS)?

A neurosurgeon performs the surgery to implant the deep brain stimulation device. A neurosurgeon will also adjust the device. A neurosurgeon specializes in surgical treatment of diseases of the brain and spinal cord. 

How is deep brain stimulation (DBS) performed?

Your deep brain stimulator device surgery takes place in a hospital. The surgery takes several hours. Your surgeon may implant the lead and the neurostimulator in two separate surgeries. The surgery generally includes these steps:

  1. You will dress in a patient gown and remove any jewelry, wigs, glasses, dentures, and any other items that may interfere with the surgery.
  2. Your care team will start an intravenous (IV) line. You will receive fluids and a mild sedative and possibly other medications through your IV. You will remain awake for the first part of the procedure, when your surgeon inserts the lead into your brain.
  3. Your surgeon will make four small injections of local anesthetic in your head to numb the area. Your care team will attach a head frame to your head with pins at the site of the anesthetic injections. The frame holds your head in the correct position for the procedure. Your care team will not need to shave your hair to fit your frame.
  4. The care team will take brain-imaging scans (pictures) to locate the area of your brain where your surgeon will place the lead. The scan might be an MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan. 
  5. Your surgeon will inject additional anesthetic medication into your scalp, drill a small hole in your skull, and insert your lead.
  6. Your surgeon will ask you to make certain movements, such as moving your face or hands, to help determine the best lead positioning.
  7. Your surgeon will verify accurate placement of the lead by attaching it to a temporary, external neurostimulator. The neurostimulator sends electrical stimulation to your lead to test its placement.
  8. Your surgeon will attach the lead to an extension wire that will connect it to your permanent, internal neurostimulator. The extension wire runs under the skin of the head, neck, and shoulder to the chest or belly. Your surgeon will close the hole in your scalp.
  9. Your surgical team will give you general anesthesia to put you into a deep sleep and your surgeon will implant your neurostimulator in your chest or belly. Your neurosurgeon will attach the neurostimulator to the lead wire and close the incision. This step may be done immediately after placing the lead in the brain or is a separate surgery about a week later.
  10. Your neurosurgeon will turn on and adjust your neurostimulator. This may occur the same day as your surgery or a week or two later. It may take a few weeks and several adjustments before your neurostimulator is adjusted precisely to relieve your symptoms.