Deep Brain

Stimulation

What Does DBS Treat?

Parkinson’s Disease

  • Significantly reduces PD motor symptoms such as tremor, slowness of movement, muscle rigidity and motor fluctuations

  • May reduce number of PD medications needed

  • Provides approximately 6 hours of more “on-medication time” per day, while dramatically reducing dyskinesias (involuntary abnormal movements caused by medications)

Essential Tremor

  • Patients with tremor experienced an average of 70% reduction of symptoms, depending on type and location

  • Many patients are able to completely stop their medications for tremor

  • Most beneficial for hand and arm tremor, but can help reduce head and vocal tremor as well

Dystonia

  • Good improvement to pain and muscle stiffness due to excessive muscle pulling

  • Can significantly improve dystonic tremor

  • Frequently can reduce or eliminate need for dystonia medications and/or botulinum toxin injections

DBS Overview

Deep brain stimulation (DBS) is surgical treatment that involves implanting electrodes into specific areas of the brain, determined by the condition being treated. These electrodes are then connected to a generator, or pacemaker-like device placed under the skin, just below the collarbone. This generator is then programmed by your clinician to deliver electrical pulses. These help to modulate abnormal neural activity, helping to alleviate symptoms.

DBS offers a customizable and reversible approach, allowing clinicians to adjust stimulation settings based on a patient’s individual needs, which can lead to significant improvements in quality of life when medications alone are insufficient.

The DBS system consists of:

  1. The electrode or lead: A very thin wire that is inserted through a small opening in the skull and placed very precisely in a specific region of the brain (subthalamic nucleus, globus pallidus, or thalamic region).

  2. The extension: This is a thin flexible wire that connects the brain lead to the generator pack. This is tunneled under the skin along the back of the head, behind the ear, and down the neck.

  3. The pulse generator: Placed under the collarbone, typically on the right side, this is the “battery pack” and looks very similar to a cardiac (heart) pacemaker. This connects wirelessly to a programming device.

What to Expect

Here at Neurosurgical Associates we have a team of specialized professionals that will work with you through this process and communicate with both you and your referring doctor to ensure a smooth process from pre-operative evaluation through surgery and post-operative device programming.

Before Surgery

The first step in the process will be for your referring doctor (primary care or neurologist) to send a referral to Dr. Paul House. We may coordinate with their office to request specific testing or evaluation prior to your first appointment.

You will then meet with Dr. Paul House or his physician assistant (Holly Cushing, PA-C) to review the surgical procedure, the expected benefits and potential risks. Please feel free to invite family to this appointment.

During this appointment we will discuss if any additional evaluation is needed. Some additional tests that may be required are:

  1. Brain Magnetic Resonance Imaging (MRI) - to check for any anatomic concerns for surgery. This scan will also be used to carefully plan the placement of each of the DBS electrodes. This scan may only be done at specific facilities to ensure adequate surgical planning quality.

  2. Neuropsychological Testing - to test for underlying cognitive concerns that would need to be considered prior to your surgery.

  3. Physical Therapy Evaluation - this can help us determine the degree of disability from disease symptoms, and help us predict your response to DBS therapy. For Parkinson’s patients we have them complete “on medication” and “off medication” testing.

  4. Medical Clearance - you may need to meet with your primary care provider or other specialists (for example - cardiology) to ensure you are cleared for surgery in regards to your other medical conditions. This may include blood work or EKG testing.

During Surgery

The DBS device is implanted in two different surgeries, each separated by a period of 1-2 weeks.

DBS Lead Placement:

While you are completely asleep under general anesthesia, your neurosurgeon will securely attach a head frame in order to keep the head very still and allow for precise lead placement. A small hole is then drilled in the skull and the electrodes are gently guided to the exact position we have planned using your pre-operative MR imaging and our image guidance systems. We have an intra-operative CT scanner that takes multiple images during the surgery to confirm precise location.

During this surgery you will be completely asleep. Following surgery you will be watched in our neuro-intensive care unit for one night. Most patients are discharged home the next morning.

Placement of the Lead Extenders and Generator:

This second surgery is to complete the system by placing the generator and extension wires. This procedure is also performed under general anesthesia (asleep). One incision is made behind the ear to get access to the brain leads, and a second incision on the chest for the generator (pacemaker). This surgery is done as an outpatient, meaning you will go home the same day. Both brain leads can be connected to a single generator (battery).

After Surgery

After the first surgery to place the brain leads you will stay overnight in the hospital. During this time your family can be present and our highly qualified nursing team will attend to any needs. At Intermountain Medical Center we have a specialized Neuro-Critical Care Unit (NCCU) where you will be watched by physicians who have done extensive training in both neurology and intensive care. We pride ourselves on the highest quality patient care, particularly as it relates to the very specific needs of our movement disorders patients.

Dr. House uses a specific method for DBS lead placement, which entails a minimally invasive approach with very small head incisions. Due to this, there is quite minimal pain after surgery and the majority of our patients require only over-the-counter pain medications after surgery.

You will be up and walking the day of surgery, and we encourage our patients to continue with light exercise in the first few weeks after surgery. It is common to have some new fatigue for the first few weeks.

DBS Programming

After you have recovered from both surgeries, you will meet with either your neurologist or Dr. House and his physician assistant (Holly Cushing) and they will program the stimulator to deliver the appropriate amount of electrical impulses to relieve your symptoms. This can take a few visits to dial in the correct dose of stimulation, and to adjust medications along with this titration.

FAQs

  • DBS is often described as a pacemaker for the brain. Electrical signals from the generator are delivered in a precise fashion to the brain. These electrical signals can help reduce abnormal neuron firing which results in improvement in motor symptoms.

  • Dr. Paul House is a board-certified neurosurgeon with over 20 years of surgical experience. In addition to the rigorous training associated with becoming a neurosurgeon, he has undergone additional fellowship training specifically in functional neurosurgery, focusing on deep brain stimulation and epilepsy surgery at one of the world’s leading neurosurgical centers.

  • This is different for each patient, but typically we suggest DBS when the patient has maximized medication therapies and is still having significant difficulties with normal tasks of daily living.

  • The most serious potential risk associated with the procedure is bleeding in the brain, occurring in about 0.5 percent to 1 percent of cases. This complication can lead to stroke, resulting in symptoms of new weakness or difficulties with speech.

    There is also a risk of infection, affecting approximately 1 percent of patients. Infection in this region is very serious, and typically requires removal of the entire DBS system and treatment with intravenous (IV) antibiotics.

  • No, here at Neurosurgical Associates we use specialized technology and advanced imaging systems to allow for the leads to be placed with high accuracy while patients are asleep. We are able to use intra-operative CT imaging to confirm precise lead placement during the operation.

  • Dr. House uses a minimally invasive procedure for DBS lead placement that he has pioneered. This allows for a very minimal hair shave (typically 1/4” x 1” for each brain lead).

  • We expect some mild headache and fatigue for 1-2 weeks after the brain lead placement. We ask that patients refrain from heavy lifting or strenuous exercise between both surgeries, and for 2 weeks after the generator placement. Most patients take 2-4 weeks off of work for surgery.

    Longterm - patients should be able to get back to all their prior activities, and more!

  • Yes, deep brain stimulation is covered for diagnoses of Parkinson’s disease, essential tremor and certain types of dystonia. There are certain symptoms and severity that must be met to ensure patients will achieve good quality of life benefit, and we will discuss these at your appointment. Our office will get formal insurance authorization prior to surgery.

Meet the Team

  • Paul House, MD

    Neurosurgeon

  • Holly Cushing, PA-C

    Physician Assistant

  • Emily Duffus, MA

    Medical Assistant

Contact Us

Interested in pursuing DBS or have additional questions? Reach out below and our DBS coordinator will get back to you shortly.