Deep brain stimulation (DBS)

People who have movement disorders, including Parkinson’s disease or essential tremor, often have symptoms that can interfere with life. Deep brain stimulation (DBS) is a surgical procedure that is used to treat a variety of symptoms, such as tremor, rigidity, stiffness, slowed movement, and walking problems, caused by these movement disorders.

In this procedure, electrodes connected to a thin wire are surgically placed in the brain. A battery is also implanted in your chest under the skin. Once these are in place, the wire from the brain runs under your skin to the battery. The electrodes are powered by the battery to produce electrical pulses that that regulate abnormal impulses in the brain. Each patient’s DBS system is programmed specifically to meet his or her individual needs.

DBS can treat symptoms of the following movement disorders:

• Parkinson’s disease: tremor, slowness and stiffness
• Essential tremor: tremor in the hands and arms and can be effective in treating head tremor
• Dystonia: abnormal contractions in the body

Neurology exam: Your neurologist will evaluate you based on a number of factors to see if you are a candidate for DBS. This is a multi-part evaluation that will include:

• A neuropsychological evaluation which evaluates your cognitive and memory function
• On/off testing: a motor test performed by a physical therapist at the Courage Kenny Rehabilitation Institute to see how your medications affect your movement symptoms

Surgical consult and surgery prep: If you are an appropriate candidate, your doctor will create images and maps of your brain to help guide the placement of leads during surgery. You will have a surgical consult with the neurosurgeon and an MRI or CT scan to capture images of your brain. 

Surgery to place the system: There are two parts to the DBS surgery which usually take place on two different days.

• Implanting very thin wires in the brain, which will require an overnight stay in the hospital
• Placing a pacemaker-like device, called the neurostimulator, under the skin of the chest, which is an outpatient procedure

Programming the stimulation settings: A few weeks after surgery, your neurologist will turn on the neurostimulator and adjust the stimulation to best control your symptoms while minimizing side effects. It will take a few programming sessions to find the stimulation levels that work best for you. You'll have follow-up visits to check your results and adjust as needed. These appointments are key to getting the results you want over time.

Checkups and ongoing care: Although you will return to your referring doctor to continue managing your primary and neurological care, it will also be important to attend all of your checkups with the neurologist who manages your DBS therapy. This neurologist will:

• Make sure that your DBS system is working properly.
• Adjust your stimulation to best control your symptoms.
• Check the battery of your neurostimulator to see if you will soon need a device replacement.

We offer a collaborative and interdisciplinary approach to serving patients and guide patients through every step of the DBS journey.

Our dedicated DBS staff include:

• Dr. Eleanor Orehek, MD - movement disorder specialist
• Dr. Kyle Nelson, MD - neurosurgeon
• Kelly Mehlhorn, RN - nurse navigator
• Tankia Barnes, CMA - care coordinator