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Advances in Deep Brain Stimulation (DBS)

Medically Reviewed by Carol DerSarkissian, MD on July 25, 2022

Deep brain stimulation (DBS) is treatment that uses electric impulses to improve how well certain parts of your brain work. It works much like the way to a pacemaker does in the heart. Just like electrical currents help the heart to beat at the right time with a pacemaker, DBS uses an implanted device to send electrical signals to your brain.

Doctors first used DBS in mainstream medicine to treat Parkinson’s disease in the 1980s. Since then, scientists have widened its uses to treat other conditions such as:

  • Dystonia (involuntary muscle contractions)
  • Essential tremor (a nervous system disorder that causes shaking)
  • Medication-resistant epilepsy
  • Medication-resistant obsessive-compulsive disorder (OCD)

You’ll need surgery for DBS. A surgeon makes small holes in your skull and inserts electrodes into your brain tissue. They’ll also do surgery to put a device with batteries under the skin in your chest.

Latest DBS Technology

Directional DBS. One of the biggest advances is the new design of the electrodes that deliver impulses to the brain. Traditional DBS devices often cause side effects because they can only send electric signals at one frequency through one location in the device.

A directional DBS can change the electric current vertically and horizontally for finer tuning. This allows your doctor to stimulate only the brain areas that are related to your specific symptoms.

The FDA approved the Boston Scientific Vercise device in 2020 to treat Parkinson’s disease tremors. It performs directional DBS using a multiple power source implantable pulse generator (IPG). This means it has several different leads that transmit electric signals instead of only one. With multiple leads, the device can change the size and shape of stimulation it sends to your brain at any given time.

A DBS with more than one lead can treat your symptoms with greater precision and fewer side effects than a traditional DBS device. It also comes with an option for rechargeable batteries, which can last up to 15 years for some people. (Non-rechargeable types last 3-5 years.)

To qualify to use it, you must:

  • Be able to operate the controller yourself
  • Be a good candidate for surgery
  • Pass a stimulation test

The Medtronic Percept is another directional DBS device that has both directional and sensing capabilities. It captures the electrical activity of the brain. It then uses that data to adjust the impulse settings so they’re just right for what you need at the time. The FDA approved it in 2020 for treating Parkinson’s disease, essential tremor, dystonia, and epilepsy that isn’t responding to medication.

It’s important to note that there’s a window of time that’s best to have a DBS device implanted to treat Parkinson’s. The ideal time is when you’re still responding to medication but are having a harder time controlling your movements with medication alone.

Remote care. After your doctor implants your device, they have to program it to your unique symptoms and needs. This used to happen in a neurologist’s office. Now a new remote programming system called Abbott Infinity DBS allows your doctor to program and adjust your system virtually while you are still at home.

These “virtual clinics” let you communicate more effectively with your doctors so you can skip multiple in-office checkups for your DBS device. From their location, they can help steer your device away from areas of your brain that are causing side effects and toward the areas that need stimulation.

You’ll meet with your neurologist by video on a smartphone or tablet. They’ll ask you about your symptoms and ask you to perform simple tasks so they can see your symptoms. Then they’ll adjust your settings remotely based on what they see. They may also adjust your medication made at that time.

DBS surgery on sleeping patients. Usually a surgeon does DBS implantation while you’re awake and off medication. But a new technique called Asleep DBS surgery allows them to do it while you’re unconscious under general anesthesia.

This can be a good method for people who are especially anxious about having DBS, especially children. Asleep DBS surgery can treat people with Parkinson’s, dystonia, and some psychiatric disorders.

The surgery takes place in two parts. The first procedure lasts less than 4 hours. A surgeon uses brain imaging technology -- usually a computed tomography (CT) machine -- to see your brain as they do the surgery.

Microelectrode recording (MER). MER is a technique surgeons can use to help them place DBS leads most effectively. MER uses electrical current at a very high frequency to precisely identify the surgical site to implant your DBS.

You have to be awake for this technique to work well. Your surgeon will ask you to do various movement and speech tasks during the procedure. While you do this, they record and map the electrical activity in different parts of your brain. This helps them identify a more precise target for the electrodes when they implant the DBS device.

Show Sources

SOURCES:

University of Michigan Health: “Deep Brain Stimulation.”

Mayo Clinic: “Deep brain stimulation.”

Frontiers in Neurology: “Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches.”

Cleveland Clinic: “Deep Brain Stimulation,” “New Directional Lead System Is Latest in a Wave of Deep Brain Stimulation Technology Advances.”

Neurotherapeutics: “Directional Deep Brain Stimulation.”

FDA: “Vercise PC and Vercise Gevia Deep Brain Stimulation (DBS) System - P150031/S028.”

YouTube: “Directional DBS: Why you need a multiple source system,” Boston Scientific.

The Michael J. Fox Foundation for Parkinson’s Research: “Currently Available Deep Brain Stimulation Devices.”

American Parkinson Disease Association: “New Deep Brain Stimulation (DBS) Technology Now Available,” “New technology from Abbott allows for remote programming of DBS device.”

Annals of Neurology: “Timing of Deep Brain Stimulation in Parkinson Disease: A Need for Reappraisal?”

Parkinsonism and Related Disorders: “Necessity and feasibility of remote tele-programming of deep brain stimulation systems in Parkinson's disease.”

Barrow Neurological Institute: “Asleep Deep Brain Stimulation (DBS) Surgery.”

Brigham & Women’s Hospital: “Asleep Deep Brain Stimulation.”

Johns Hopkins Medicine: “Deep Brain Stimulation.”

University of Pittsburgh: “Micro-Electrode Recording.”

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