Deep brain stimulation (DBS) is a technology that has been utilized for many decades to manage chronic pain syndrome. DBS is a nonsurgical treatment that delivers small electrical shocks to inactivate the parts of the brain that cause involuntary movements in patients with movement disorders.
At Temple, DBS is used to treat Parkinson’s disease, a degenerative disorder that impacts the neurons in the brain that produce dopamine. Tremor is a common symptom associated with Parkinson’s disease, and is one that may also be addressed through the use of DBS.
How Deep Brain Stimulation Works
Before doctors determine a patient is an appropriate candidate for DBS, patients may undergo a series of meetings with neurologists and neurosurgeons, as well as evaluations with physical and speech therapists. The patient will be cleared for surgery with a series of tests that includes blood work, a chest X-ray and an electrocardiogram. If the patient is cleared for DBS, surgery is scheduled.
Day of Surgery
On the day of the surgery, the patient’s head is fitted with a stereotactic frame topped by a localizing device. An MRI is performed, and the frame and the localizing device provide markers visible on the MRI for the area that will be targeted during the procedure. Using specialized software and the MRI results, the doctor can map the brain, identifying the exact location in the brain where nerve signals that cause involuntary muscle movements or tremors occur. Based on this information, the exact path coordinates necessary to place the electrode or electrodes are determined.
Once the patient is in the operating room, the stereotactic frame is secured and anesthesia is administered. Using the MRI results, the surgeon creates holes in specific locations in the skull, and a recording electrode is navigated through those holes and placed deeply into the brain at a precise angle and depth. Once doctors determine the electrode is in the right location on both sides of the brain, the permanent leads are placed and the device is tested and the incision is closed. Patients usually remain in the hospital overnight.
During the second part of the surgery, a pacemaker-like stimulator/battery pack is placed under the skin in the chest cavity or abdomen. The leads from the scalp are then attached to an extension wire that goes under the skin from the scalp and connects to the stimulator.
About two weeks later, patients return to the office so the physician can adjust the device to use the appropriate amount of stimulation to restore balance in the circuits of the brain and control symptoms.
When the generator is on, patients with essential tremor notice immediate quieting of the tremor. However, when the generator is turned off, that tremor returns almost instantaneously. The good news is that the generator may stay on constantly, and its battery lasts for three to four years.
Who Is a Good Candidate for Deep Brain Stimulation?
The best candidates for DBS are those who are younger than 80 and:
Have idiopathic Parkinson’s disease
Have intact cognitive function
Have symptoms that are worsening
Are in good health with no serious comorbid conditions, such as cardiac disease, hypertension or other systemic illnesses
Don’t have cardiac pacemakers and defibrillators
Additionally, physicians may test DBS candidates using a medication called sinemet. For this test, patients go off Parkinson’s medications for 12 hours and motor function is evaluated. Following a dose of sinemet, motor function is again evaluated. If a 30 percent improvement is seen, the patient is considered a good candidate for DBS.
Deep Brain Stimulation for Parkinson’s Disease
Parkinson’s disease results when some of the nerve centers in the brain lose their ability to regulate muscle movement. As a result, an individual may have rigid muscles, tremors and difficulty walking and swallowing. Our nationally recognized physicians are experts in DBS in which a stimulator is implanted to assist with movement disorder. The stimulator is placed deep within the thalamus of the brain and is attached by an internal wire to a pacemaker-like stimulator in the chest cavity. This stimulator can be programmed and controlled to help reduce or eliminate the tremors associated with Parkinson’s disease.
Why Temple Health for Deep Brain Stimulation?
The neurology team at the Neurosciences Center is highly experienced in advanced procedures, such as DBS, to address neurological conditions. Specialists provide care tailored to address the unique needs of each individual patient living with neurological conditions that result in movement disorders.
When neurodegenerative diseases, such as Parkinson’s disease, cause the death of brain cells, and when the disease no longer seems to be responding to medications to treat the condition, the board-certified neuroscience experts may recommend DBS.
One of Philadelphia’s premier facilities for neurological disorders, the Temple Neurosciences Center is equipped with a state-of-the-art diagnostic center and staffed by leading neurology, neuroradiation and neurosurgery professionals.