There’s no getting around it. Deep brain stimulation, or DBS, requires brain surgery. And that ─ understandably ─ makes people nervous. But DBS might not be as invasive or scary as you think.
DBS can be a powerful treatment for patients with Parkinson’s disease or essential tremor. Tiny electrodes, or leads, are placed in the brain and connected to a pacemaker-like device. The device sends low-voltage electrical pulses to help control movement. Many patients enjoy dramatic gains in quality of life.
DBS isn’t for everyone and, like all surgery, it carries some risks. Still, if you or a loved one has considered DBS, here are seven facts you might like to know about how it’s done at OHSU:
1. You don’t have to be awake.
Until this decade, patients had to remain awake during DBS surgery. The surgeon needed the patient to respond to questions or commands to make sure the leads were placed correctly. Sometimes the leads had to be moved. Many hospitals still use this method.
At OHSU, neurosurgeon and scientist Kim Burchiel, M.D., introduced “asleep” DBS in 2011. The patient is placed under general anesthesia, and the surgeon uses MRI and CT scans taken before and during surgery to place the leads in exactly the right spots.
A study of 60 patients at OHSU, published in the Journal of Neurosurgery, showed this technique is exceptionally precise. Asleep DBS is also less expensive, according to another study published in the journal. In addition, the surgery is faster and safer, and patients avoid the anxiety of being awake.
2. DBS doesn’t destroy brain tissue.
Some other surgeries for Parkinson’s disease or essential tremor use a technique called “lesioning” or “ablative brain surgery.” In essence, the surgeon destroys a tiny part of the brain. That means there’s no going back. Surgeries that use this technique include pallidotomy and thalamotomy.
DBS, on the other hand, is reversible. Placement of the leads ─ which are skinnier than strands of uncooked spaghetti ─ does not damage adjacent brain tissue. This also means that if DBS doesn’t work as expected or if some better technology comes along, the system can be turned off or removed.
3. The incisions are small.
DBS involves one or two incisions in the skull ─ each smaller than a dime ─ made with a surgical drill. A frame holds the patient’s head securely in place. Hair is shaved only from the incision areas.
Dr. Kim Burchiel is an OHSU neurosurgeon and pioneer in deep brain stimulation surgery.
After the leads are placed, the openings in the skull are covered with secure caps, and the skin is closed. The patient’s hair grows back.
4. The DBS wires won’t show.
Talk of electrodes and wires might conjure images of Frankenstein and protruding metal. The DBS system, however, is all under the skin.
The pacemaker-like device, called a “stimulator” or “implanted pulse generator,” is about the size of a tea bag. It’s placed under the skin, usually in the chest below the collarbone. It’s attached to thin wires ─ again, skinnier than uncooked spaghetti ─ that are placed under the skin of the head, neck and shoulders. The wires are attached to the leads.
The outline of the stimulator may be visible if someone is undressed, especially if the person is thin. But it won’t show through clothing. The caps in the skull create slight bumps, but they’re usually covered by hair.
5. DBS is not experimental for Parkinson’s or essential tremor.
The U.S. Food and Drug Administration approved deep brain stimulation as a treatment for essential tremor in 1997 and for Parkinson’s disease in 2002.
At OHSU, Burchiel was the first in the United States to treat a Parkinson’s patient with DBS ─ back in 1991 as part of a clinical trial. Since then, Burchiel has done the procedure more than 1,000 times. He leads one of the most experienced DBS teams in the U.S., with a record of excellent outcomes and very few complications.
Researchers are conducting studies to see if DBS is effective in treating other conditions, such as Alzheimer’s disease or depression. So while DBS is a long-established therapy for Parkinson’s and essential tremor, its full application may still be evolving.
6. DBS patients spend little time in the hospital.
You might think brain surgery would require a long hospital stay. But with DBS, most patients at OHSU spend just one night in the hospital after the leads are put in. Some spend two. The stimulator is typically placed two to seven days later, in an outpatient procedure.
7. DBS won’t keep you from normal activities.
DBS patients need time to recover from surgery. But once they’re healed up, they can resume regular activities such as swimming, traveling and sexual activity.
The DBS team at OHSU carefully screens patients. The team also explains benefits and risks in detail. Learn more on OHSU’s DBS website.