Deep Brain Stimulation

Deep Brain Stimulation at Mayo Clinic

Deep brain stimulation (DBS) is a neurosurgical treatment which stimulates the brain with mild electrical signals. The signals reorganize the brain's electrical impulses, causing improvements in symptoms in a number of conditions affecting the brain.

Developed in Europe, DBS was approved by the U.S. Food and Drug Administration for use in treating a movement disorder known as essential tremor in 1997 and for Parkinson's disease in 2002.

The treatment was first used in the United States in 1997 by neurosurgeons at Mayo Clinic in Jacksonville. Mayo specialists have successfully used DBS to treat hundreds of patients with essential tremor, Parkinson's disease and dystonia. They have recently begun using DBS to treat cluster headaches. Mayo physicians are planning on trying DBS as a treatment for people with depression, obsessive-compulsive disorder and chronic pain that has not responded to other forms of treatment.

Deep brain stimulation has dramatically changed the lives of many patients with uncontrollable tremors. Patients often can resume normal activities, such as feeding and dressing themselves, and can have active and fulfilling lives. The need for anti-tremor medications is often reduced or eliminated.

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How it works

A thin, insulated wire lead with four electrodes at the tip is surgically implanted into the affected area of the brain. A wire runs under the skin to a battery-operated pulse generator implanted near the collarbone. The generator is programmed to send continuous electrical pulses to the brain. It can be turned on or off when the patient swipes a special magnet over the generator. (Movement disorders patients typically turn off the device at night, because tremors usually stop during sleep.)

To implant the electrodes, a neurosurgeon uses a stereotactic head frame and magnetic resonance or computed tomography imaging to map the brain and pinpoint the problem area. The patient's scalp is anesthetized before the procedure, but the patient is awake to report side effects while the electrodes are placed . This allows the lead to be placed for maximum effectiveness and minimum side effects. The patient will receive sedation or general anesthesia before the wire lead and the pulse generator are implanted.

Deep brain stimulation can be done on one or both sides of the brain, depending on the disorder and the patient's problems.

Side effects are generally mild and reversible. The most common are a temporary tingling in the limbs, slight paralysis, slurred speech and loss of balance.

Battery life varies with usage and settings. The battery should last about five years with 16 hours of use a day. When the battery needs to be replaced, the pulse generator is replaced, usually while the patient is under local anesthesia during an outpatient procedure.

The procedure is expensive. It uses both sophisticated surgical and implanted equipment, in addition to the cost of surgery and hospitalization. Medicare and many insurance plans cover most costs associated with deep brain stimulation for movement disorders. Other uses of deep brain stimulation will likely be covered in the future.

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