Choosing DBS for Essential Tremor

Deep brain stimulation, or DBS, is a type of surgery that can help people with movement disorders. A surgeon places tiny wires called electrodes in certain areas of the brain. The electrodes are connected to a small device that sends signals to the brain. When this happens, the electrodes correct faulty brain signals that cause essential tremor. This can help certain symptoms, such as hand and leg tremors.

If medication does not control your essential tremor, or you have such severe medication side effects that you cannot take enough to control your tremor, deep brain stimulation might be an option for you. This surgery does not cure essential tremor, but it has been shown to reduce symptoms in many people who try it. The information on this page can help you decide if you should consider DBS.

DBS could be for you if:

  • Your propranolol, primidone or other medications do not work as well as they used to.
  • You have severe side effects from your medication.
  • Side effects keep you from taking enough medication to control your essential tremor.

When your essential tremor keeps you from doing things you need or want to do, and medication does not control it well any longer. For example, if essential tremor makes it very difficult to eat and drink, DBS could be a good option.

You should also consider DBS if your medication causes such severe side effects that you cannot take a high enough dose to control the tremor.

If you are interested in DBS, talk to your doctor about the information on this site. The OHSU Movement Disorders Program is a leader in deep brain stimulation. Dr. Kim Burchiel brought DBS to the United States in 1991 and was the first to do it successfully. He was also the first to do “asleep” DBS in the U.S., with the patient under general anesthesia.

OHSU’s team of specialists focuses on your individual situation to give you as much information as possible. If DBS is not right for you, we can talk with you and your neurologist about medication options.

DBS mainly helps with action tremors of the leg and hands. It is not as helpful with voice or head tremor.

  • DBS can improve your quality of life by reducing tremor.
  • DBS works 24 hours a day, so you depend less on medication to control your symptoms.
  • DBS is reversible. Your doctor can reverse DBS by turning off the implanted pulse generator, also called the stimulator or IPG. So if other treatments become available, you can try them.
  • DBS is adjustable. Your doctor can adjust the stimulator to make it work more effectively and reduce side effects.
  • DBS is renewable. The batteries last three to five years and your DBS team can replace them. You can turn your DBS stimulator off at night to make the batteries last longer.

The most effective and safe alternative to DBS for essential tremor is focused ultrasound. For this treatment, we create a small lesion on the part of the brain causing the tremor.

Focused ultrasound has fewer risks than DBS because it does not use incisions. However, focused ultrasound can only treat one side of your body.

Another surgery for essential tremor is called a thalamotomy. For this surgery, a neurosurgeon removes a small part of the brain in an area called the ventral intermediate thalamus. This procedure has been done for many years. But it does damage the brain. Also, surgery on both sides of the thalamotomy can cause problems with speech.

The best procedure for you depends on your individual symptoms and health. The OHSU movement disorders team will talk with you about all your essential tremor treatment options.

Medications are a good choice for some people with essential tremor. For voice and head tremor, medication may still be the most effective option. However, medications can work less well as time goes on. They can also cause side effects. If you need more and more medication, the side effects can also increase. This can make it hard to take enough medication to control your symptoms. We will work with you to tailor the most effective treatment plan.

In "asleep" DBS, developed by OHSU's Dr. Kim Burchiel, the patient is placed under general anesthesia. The patient is not aware of any part of the procedure. The neurosurgeon uses high-resolution scans taken before and during surgery to precisely place the tiny electrodes in the brain. "Asleep" DBS is faster and safer. Patients can also take their medication on the day of surgery.

In "awake" DBS, the patient must remain awake during surgery. This is because the patient needs to respond or perform tasks to help the neurosurgeon correctly place the DBS electrodes in the brain. Many patients are anxious about being awake during brain surgery. They also must refrain from taking their medication on the day of surgery.  OHSU no longer performs awake DBS.

How does my neurosurgeon test the electrodes if I am asleep?

Your neurosurgeon does CT scans, sometimes called CAT scans, during surgery. Your neurosurgeon compares these with the high-resolution MRI you had before surgery. By comparing these precise scans, your neurosurgeon knows when the electrodes are in the right place. He or she can find the best location without having to move the electrodes around, as in awake DBS.

The cost of DBS is different from person to person, depending on insurance and other factors. The OHSU Movement Disorders Program will work with you to help you learn about insurance coverage and costs.

Does Medicare cover DBS?

Yes, if you qualify. Read the Medicare standards for DBS or contact them if you have more questions. If you meet the Medicare standards for DBS, you do not need Medicare approval before surgery. You must still pay deductibles, co-insurance, and co-payments.

What about other health insurance?

Non-Medicare health insurance often covers DBS if you get approval before surgery. Your doctor’s office usually has to work with the company to have them approve the procedure for you. Your doctor often writes the insurance company a letter saying why DBS is appropriate for you. It also describes other treatments you have tried that do not work well.