Deep brain stimulation (DBS) is used to treat a number of movement disorders, including essential tremor. DBS is a way to inactivate the thalamus, a structure deep in the brain that coordinates and controls muscle activity. The true cause of essential tremor is still not understood, but it is thought that the abnormal brain activity that causes tremor is processed through the thalamus.
How Effective Is Deep Brain Stimulation?
Deep brain stimulation provides moderate relief for approximately 90% of patients with essential tremor.
How Does Deep Brain Stimulation Work?
To treat essential tremor with deep brain stimulation, electrodes are placed in the thalamus during surgery. The electrodes are connected by wires to a type of pacemaker device (called an impulse generator, or IPG) implanted under the skin of the chest, below the collarbone. Once activated, the device sends continuous (painless) electrical pulses to the thalamus, blocking the impulses that cause tremors. This has the same effect as thalamotomy without actually destroying parts of the brain.
The IPG can easily be programmed using a computer that sends radio signals to the IPG. Patients are given special magnets so they can externally turn the IPG on or off.
Depending on use, the stimulators may last three to five years. The IPG replacement procedure is relatively simple.
What Are the Pros and Cons of Deep Brain Stimulation?
Advantages of deep brain stimulation include:
- It doesn't destroy brain tissue and won't limit future treatment.
- The device can be removed at any time.
- It is adjustable.
- It may be more effective in controlling tremors than thalamotomy, or destruction of the thalamus.
Disadvantages of deep brain stimulation include:
- Increased risk of infection from the presence of a foreign object in the body
- Repeat surgery every three to five years in order to replace the battery in the device
- Uncomfortable sensations that may occur during stimulation
Who Should Consider Deep Brain Stimulation?
There are many important issues to be addressed when considering deep brain stimulation. These issues should be discussed with a movement disorders expert or a specially trained neurologist.
Before considering DBS, you should exhaust all medication options. Surgery is not recommended if medications can adequately control the disease.
What Happens During Deep Brain Stimulation Surgery?
Using CT or MRI scans, surgeons will target areas for placement of the electrodes. Some doctors may use an electrode-recording technique to map and target the specific areas in the brain they will need to reach.
Once the correct location is identified, the permanent electrodes are implanted in the brain. The loose ends are placed underneath the skin of the head and the incision is closed with sutures. The wires are attached to a small impulse generator, about the size of a pacemaker, that is placed under the skin on the upper chest. Two to four weeks later, the IPG is turned on and adjusted. It may take a few weeks until the stimulators and medications are adjusted before a person gets relief from symptoms.
What Are the Risks of Deep Brain Stimulation?
As with any surgical procedure, there are risks of deep brain stimulation. There is a small risk of a serious and permanent complication such as bleeding in the brain, paralysis, seizures, infection, and changes in thinking, memory and personality. Discuss these risks with your doctor.
Will I Be Asleep During Deep Brain Stimulation Surgery?
You will remain awake but in a type of "twilight" zone during most of deep brain stimulation surgery. This allows the surgical team to interact with you when testing the effects of the stimulation. Small amounts of local anesthetic (pain-relieving medication) are given in sensitive areas. The vast majority of people experience minimal discomfort during the procedure.
What Should I Expect After Deep Brain Stimulation Surgery?
After deep brain stimulation surgery, you may feel tired and sore but will be given medication to keep you comfortable. Also, you may have irritation or soreness around the stitches and pin sites.
As with any surgery, there are some guidelines and limitations that you should follow after DBS. Be sure to discuss these with your doctor and ask questions before surgery. Understanding what you will be experiencing and knowing what to expect afterward can help ease some of the natural anxiety that comes with any medical procedure.
When Will I Be Able to Go Home After Deep Brain Stimulation Surgery?
The average hospital stay for deep brain stimulation surgery is two to three days.
How Should I Care for the Surgical Area Once I Am Home?
- Your stitches or staples will be removed seven to 10 days after surgery.
- Each of the four pin sites should be kept covered with band-aids until they are dry. These should be changed every day as necessary.
- You will be able to wash your head with a damp cloth, avoiding the surgical area.
- You may shampoo your hair the day after your stitches or staples are removed, but only very gently.
- You should not scratch or irritate the wound areas.
Will I Have to Limit Activity Following Deep Brain Stimulation?
- You should not engage in light activities for two weeks after deep brain stimulation surgery. This includes housework and sexual activity.
- You should not engage in heavy activities for four to six weeks after surgery. This includes jogging, swimming, or any other aerobic activity.
- You should not lift more than five pounds for at least two weeks.
- Depending on the type of work you do, you may return to work within four to six weeks.
Warning About Deep Brain Stimulation
Call your doctor immediately if you experience any of the following symptoms after deep brain stimulation surgery:
Can I Use Electrical Devices After Deep Brain Stimulation?
While you should be able to use most electronic devices after DBS surgery, you should be aware that:
- Some devices, such as theft detectors and screening devices, like those found in airports, department stores, and public libraries, may be triggered by your device. It may take extra time to go through airport security. Always carry the identification card given to you. With this, you may request assistance to bypass those devices.
- You will be able to use home appliances, computers, and cellular phones. They do not usually interfere with your implanted stimulator.
- You will be provided with a magnet to activate and deactivate your stimulator. This magnet may damage televisions, credit cards, and computer discs. Always keep it at least one foot away from these items.