Deep Brain Stimulation


If you’re suffering from a movement disorder such as Parkinson’s or essential tremor, and your symptoms cannot be adequately controlled with medications, you may want to consider deep brain stimulation (DBS).

Similar to a pacemaker that regulates the heart’s rhythm, DBS uses an implanted device to send electrical signals to specific areas of your brain. These impulses help block or disrupt abnormal brain activity that is causing movement-related symptoms, such as tremors, slowness of movement, stiffness and walking problems.

DBS involves inserting electrodes in the brain and wires under the skin that connect to a pulse generator (neurostimulator) implanted in your chest area. Once in place, you will use a remote control to activate the electrical stimulation going to your brain.

Although DBS will not slow the progression of the underlying neurologic disorder, it does allow many people to better manage their symptoms, reduce their medications and improve their quality of life.

How Do I Know If I’m a Good Candidate for DBS?

The best candidates for DBS will meet most of the following criteria:

  • You’ve experienced symptoms for at least five years.
  • You have “on/off” fluctuations, with or without dyskinesia.
  • You respond well to medications like carbidopa/levodopa.
  • Your doctor has already tried different combinations of carbidopa/levodopa and dopamine agonists.
  • You’ve tried other medications, such as entacapone, tolcapone, selegiline, apomorphine or amantadine, without results.
  • You have symptoms that interfere with your daily activities.

What to Expect with DBS

Implanting the DBS devices and fine tuning how they work is a team effort that requires two surgical procedures. You’ll likely start by seeing a Mercy movement disorders neurologist who will review your medical history and perform a neurological exam.

If you are a candidate for DBS, your doctor will refer you to a neurosurgeon and neuropsychologist for testing. The neuropsychologist will make sure you do not have dementia or other cognitive disorders, which could potentially prevent you from having DBS surgery. You may also see a speech therapist and physical therapist for an initial evaluation.

Before surgery, your neurosurgeon will run an MRI scan of your brain to determine the placement of the electrodes.

Brain Surgery

During your first surgery, your care team will use a special head frame to keep your head still during surgery. You are awake for part of the procedure, but you won’t feel any pain because you’ll have local anesthesia. After placing the electrodes and wires (leads), an electrophysiologist interprets electrical signals to ensure everything is working properly. After surgery, you’ll stay in the hospital overnight for monitoring.

Pulse Generator Placement

About a week later, you will undergo a second surgical procedure to implant the pulse generator in your chest area. You will not be awake during this procedure.

After the Procedures

About a month after your second surgery, you will meet with your movement disorders neurologist to activate and program the pulse generator. A remote control is used to communicate with the generator inside your chest. You will take the remote control home with you so you can turn the stimulation on and off. Your doctor will make programming adjustments as needed.

The battery inside the generator will probably last between three to five years, depending on how much stimulation is needed. Your neurosurgeon can replace the battery during an outpatient procedure.

The pulse generator will need to be replaced at some point – probably closer to nine years. That will require another surgery.

Deep brain stimulation is a serious and potentially risky procedure. It doesn’t work for everyone. It’s important to discuss the risks and potential benefits with your Mercy neurology care team. Our goal is to help you minimize your movement disorder symptoms and live the best life possible.

Deep Brain Stimulation

Dr. Cherian Karunapuzha

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