Deep brain stimulation (DBS) is a procedure where electrodes are placed in specific areas of the brain. The electrodes block the abnormal brain circuitry seen in patients with neurological conditions such as Parkinson’s disease, tremors and dystonia.
DBS does not destroy the overactive cells, like other movement disorders treatments such as pallidotomy and thalamotomy surgeries. Rather, it temporarily blocks the abnormal signals and is a reversible process. In DBS, a lead is permanently implanted into your brain and connected to a generator, which is attached under the skin of your chest.
Deep Brain Stimulation Expertise at Wake Forest Baptist
The Movement Disorders Center (MDC) at Wake Forest Baptist has one of the most experienced deep brain stimulation teams in the country. We were among the first centers in the nation to use DBS in patients with Parkinson’s disease and we continue to innovate in the use of this treatment in other FDA-approved movement disorders, including essential tremor, dystonia and obsessive-compulsive disorder.
Our specialists work closely with a multidisciplinary team to develop an extensive, individualized plan for each patient. The MDC coordinator helps referring providers and patients navigate our system and provides you with the best possible medical experience.
Conditions and Symptoms Improved by Deep Brain Stimulation
DBS has been shown to improve all the symptoms of Parkinson’s disease that respond to L-dopa (Sinemet) treatments. The exception is tremor, which responds well to DBS even if it did not previously respond well to medications.
However, not all symptoms of Parkinson’s disease improve with surgery.
Patients with essential tremor, dystonia and obsessive compulsive disorder may be candidates for DBS if medication has failed to provide relief.
It is important to note that patients with dementia in addition to movement disorders are not candidates for deep brain stimulation.
Because of the DBS risks, it is only recommended for patients whose quality of life is significantly impaired by their movement disorder. Determining “significant impairment” is best done by yourself, your physician, and your loved ones.
Deep Brain Stimulation Evaluation
If you have been referred to the Movement Disorders Center, you will undergo a comprehensive evaluation for level of qualification and DBS risk.
Your DBS-trained movement disorders neurologist will confirm your diagnosis, grade its severity, ensure your medications are optimized, and determine and explain which symptoms can be expected to respond to surgery.
You will undergo a thorough evaluation by a team of neurosurgeons, neurologists, psychiatrics, neuropsychologists and therapists. This evaluation includes a detailed health history, neuropsychological evaluation, psychiatric evaluation, physical exam and, potentially, a videotaped evaluation both on and off your medicine.
Not all patients need DBS; we often advise patients whose conditions are well managed with current medication to defer surgery to a later time.
How Deep Brain Stimulation Works
Once your screening process is completed and your movement disorders team ensures that DBS is right for you, you will undergo the surgery.
The surgery is performed in a state-of-the-art operating room suite, equipped with the latest technology, like our sophisticated image guidance that uses microelectrode recording to ensure optimal placement of the device.
Surgery is performed in 2 stages, several weeks apart. In the first stage, your neurosurgeon will place electrodes in your brain. You will need to be admitted to the hospital for this procedure.
In the second stage, we place the generator, the electrodes’ power source, in your chest and connect it to the electrodes with an extension. This is usually an outpatient procedure.
Following the surgery, you will receive specialized postoperative care and support. To ensure best results, we ask our patients to return for multiple visits just after implantation, during which the generator is reprogrammed and medications are adjusted to improve symptoms and decrease side effects.
Follow-up appointments are scheduled less frequently once we have obtained optimal balance of medication and symptom control.
The generator typically lasts 2 to 5 years; replacement can be performed in a routine outpatient surgical procedure.
Risks Associated with Deep Brain Stimulation
Any surgery comes with risks, and DBS is no exception. However, the DBS risk of morbidity and mortality is relatively low, at approximately 5 percent. The major DBS risk is hemorrhage or bleeding in the brain, equivalent to having a stroke. In addition, a deep brain stimulator is a foreign object implanted in your body, so there is a risk that it could become infected and need to be removed.
Other DBS risks in Parkinson’s patients include such side effects as weakness or coordination problems, which usually improve over time. Some patients report personality or cognitive changes, though most do not. For procedures affecting the thalamus, a speech difficulty called dysarthria may occur.
We are able to minimize most side effects by intraoperative physiologic testing during the procedure.
Deep Brain Stimulation Appointments
Ask your doctor for a referral to our Movement Disorders Clinic.
Please ensure your referring physician has the following records sent to us:
- Copy of insurance card (front & back)
- Office notes
- Medication list
- MRI/CT films (not just the report)
Items to bring with you to your appointment:
- Completed forms (received in the mail from us)
- All medications in the bottle
- Caregiver and family involved in your care
For more information, or to begin to assess DBS risk, call our program coordinator at 336-716-4101.
Deep Brain Stimulation Cost
The cost for DBS is covered by most insurance companies, just like any other surgery is covered. Ask your insurance company if they cover the FDA-approved deep brain stimulator.