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Deep Brain Stimulation: How it Works, Success Rate, Pros & Cons

Deep Brain Stimulation: How it Works, Success Rate, Pros & Cons

Deep Brain Stimulation is a treatment option for people who suffer from conditions such as Parkinson’s, dystonia, essential tremor, epilepsy, and OCD.

Deep brain stimulation uses electrical stimulation, deep in the brain to restore regular brain activity that causes the disease and reduces symptoms. 

If you or a loved one is suffering from one of these debilitating diseases, DBS might be the right treatment option.

Here are some quick facts about Deep Brain Stimulation before we get started:

  • DBS is not a cure, but it significantly reduces symptoms and improves quality of life.

  • DBS might not work for everyone.

  • DBS does not stop disease progression, or reverse the disease.

  • DBS treatment has been approved by the FDA for over 20 years.

  • DBS as a treatment was first used in 1987 by a group of researchers in France.

  • According to research from 2019 by Andres M Lozano et al, over 160.000 individuals have received DBS treatment. 
Deep Brain Stimulation

What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a treatment for various movement disorders, psychiatric conditions, and neurological illnesses.

During DBS surgery, thin wires with electrodes on them are placed in a specific part of the brain associated with the patient’s symptoms. The wires are connected to a device called a “neurostimulator”, which is placed on the collar bone, chest area, or abdomen.

The neurostimulator device generates electrical impulses, and the electrodes receive these impulses via the wire. The electrodes conduct these pulses into the brain, to the area they’re located in.

Neurological conditions are caused by irregular activity in the brain, so when an electrode sends pulses into the brain it can help regulate these activities and cause a reduction in symptoms. 

How does Deep Brain Stimulation work?

There is no scientific consensus on how deep brain stimulation works exactly. However, the general understanding is that the electrical pulses sent by the neurostimulator device alter brain activity, and it can do this in a few different ways.

  • If you have too much or not enough brain activity in the area, it can bring it to a normal range.

  • If the brain activity is irregular or abnormal, it can regulate activity.

  • And if the abnormal signals are not allowing the different regions of the brain to communicate, electrical stimulation will override the abnormal signals, and allow communication.
How Does Deep Brain Stimulation Work

What is the Deep Brain Stimulation success rate?

Different criteria can be used to determine the success rate of DBS surgery, here are some examples:

  • For patients with Parkinson’s, DBS improves motor symptoms by 30-60% and reduces medication use by half according to research from the University of Toronto. 

  • DBS improved the tremor of 72,5% of Parkinson’s patients. 92,5% of the patients were happy that they got DBS, and 95% of them would recommend it. It was also observed that after 10 years of living with DBS, half of the patients were still alive and well according to a paper about the long-term effects of DBS published in the Journal of Neurosurgery. 

  • Patients with Parkinson’s still report an improved quality of life after living with DBS for 15 years, even though the disease progressed according to research from CHU Grenoble Alpes University Hospital.  

What is Deep Brain Stimulation used for?

Deep brain stimulation is used as a treatment for various movement disorders, neurological conditions, and psychiatric disorders. It can be used for managing symptoms, in conjunction with medications and other therapies.

In most cases, DBS is the last line of treatment as it’s an invasive procedure, and is recommended to patients that are not responding to other treatments.

For some of these diseases, the treatment is approved by the FDA, and readily available in many specialty practices. For others, the treatment is not approved and patients can only get DBS treatment if they are treatment-refractory.

Is Deep Brain Stimulation FDA-approved?

Yes, deep brain stimulation is FDA-approved for the treatment of the following diseases:

  • Essential tremor (approved in 1997)

  • Parkinson’s disease (approved in 1997)

  • Dystonia (approved in 2003)

  • OCD – Obsessive-compulsive disorder (approved in 2009)

  • Epilepsy (approved in 2018)

Currently, DBS is used in clinical trials as an experimental treatment option with promising results for various diseases. In the future, there is a chance that DBS can be an FDA-approved treatment for the following diseases:

  • Anxiety Disorder

  • Major Depression

  • Anorexia Nervosa

  • Morbid Obesity

  • Bipolar Disorder
  • Borderline Personality Disorder

  • Substance Abuse Disorder

  • PTSD

  • Schizophrenia

  • Tinnitus
  • Cluster Headaches

  • Chronic Pain

  • Cerebral Palsy

  • Alzheimer’s Disease

  • Huntington’s Disease
  • Dementia

  • Multiple Sclerosis

  • Stroke

  • Vegetative State

  • Minimally Conscious State

Is Deep Brain Stimulation safe?

Deep brain stimulation is considered to be safe and effective, with mild and temporary side effects, and uncommon complications.

Because the implantation of the device requires brain surgery, DBS surgery carries similar risks to other brain surgeries; such as bleeding, or infection.

After the surgical procedure, the side effects of stimulation are very mild and they can be easily eliminated by changing the settings on the device.

We have a full article where we talk about the risks, complications, and side effects of DBS surgery and stimulation, you can read it to get more information on complication rates, and what you can do if you encounter a problem.

Is Deep Brain Stimulation invasive?

Yes, and no. The DBS device implantation surgery is considered invasive, but the actual stimulation aspect of the treatment is minimally invasive.

Is Deep Brain Stimulation permanent?

No, the stimulation can be turned off and the device can be removed if the treatment doesn’t work out for you. In addition, your doctor can instruct you to turn off the device at certain times of the day. So you neither have to live with the device nor have it on all the time for the rest of your life if it doesn’t end up working for you.

However, there’s an extremely rare complication associated with DBS removal in Parkinson’s patients called DBS withdrawal. If the patient is experiencing this, the device should be reinstalled. 

Who is a good candidate for Deep Brain Stimulation?

The candidacy requirements for DBS surgery change depending on what kind of diagnosis you have, but here are some common grounds:

  • You are experiencing severe symptoms that are reducing your quality of life.

  • You are not responsive to appropriate medicine dosages or the symptoms come back after the medications wear off.

  • You can’t use medications due to severe side effects.

  • You can’t have other forms of treatment.

  • You are in good health to go through surgery.

DBS is not suitable for you if you have any of the following problems:

  • You are not healthy enough to go through surgery.

  • Have a pacemaker for your heart (DBS devices and pacemakers can interact and cause problems).

  • Have to get frequent MRI scans (you can only get MRI-compatible devices).

  • Are on blood thinning medications

  • Have a history of psychotic disorders, bipolar disorder, body dysmorphic disorder, or substance abuse disorder.

  • Have depression or anxiety (should be treated before surgery).

  • Have dementia.

Is there an age limit for Deep Brain Stimulation?

Deep brain stimulation treatment has no upper or lower age limit. For example, the youngest patient to receive DBS treatment was a 2-year-old baby who had dystonia. In case of older age, DBS might not work as well for patients who are over 70 years old.

Deep Brain Stimulation Surgery

The road to getting DBS surgery starts with appropriate preparation and tests. If the patient qualifies for the surgery, the treatment can proceed.

First, the neurosurgeon determines which type of DBS surgery is best for the patient. The surgical procedure for DBS has 2 steps. The first step is brain surgery, where electrodes are implanted in the brain. The second part of the surgery involves implanting the neurostimulator device into the chest area.

After patients recover from the initial surgery, the device can be turned on and calibrated. This is the stage where patients will experience the effects of stimulation. After recovery, patients will need long-term monitoring and might need to go through battery replacement surgery in the future.

Are there different types of Deep Brain Stimulation surgery?

Yes, there are different types of DBS and they include the surgery method (asleep, awake, robotic), placement of leads (bilateral or unilateral), and stimulation modes of the leads (unipolar, bipolar, interleaving, multiple level, directional).  A method called Adaptive DBS is currently under investigation. We have a full article explaining all of these different types of DBS methods, if you’re interested.

Types Of Deep Brain Stimulation Scaled 1

Are there different Deep Brain Stimulation device placements for different diseases?

Yes, there are different Deep Brain Stimulation device placements for different diseases. For Parkinson’s disease, the Subthalamic Nucleus and Globus Pallidus Internal are the most common lead placement areas. For essential tremor, the Ventral Intermediate Thalamus is targeted. For dystonia, Globus Pallidus internal is targeted. For OCD, the target is the Anterior Limb of the Internal Capsule. For epilepsy, the Anterior Nucleus Thalamus is targeted. 

Many more brain areas can be targeted experimentally, or based on symptoms. We have a full article explaining each DBS placement based on the disease, and which symptoms it can improve that you can read for more information. 

Deep Brain Stimulation Lead Placement

How does evaluation work for Deep Brain Stimulation?

The evaluation for Deep Brain Stimulation works as follows:

  • You’ll be evaluated by a team of professionals who will assess your motor skills, movements, cognitive function, memory, speech, and psychological condition.

  • You’ll go through some basic tests that will determine if you are in a good condition to go through surgery. These include; blood and urine tests.

  • You’ll have to take an MRI and CT Scan to map out your brain. This will help doctors determine where to put the device.

  • You’ll have to go through your medical history, and treatments you’re on, any medications, vitamins, or supplements you’re using, and any other diseases you have.

  • Doctors will observe how you respond to your medication. To do this, they will evaluate your different skills both on and off medication.

  • You’ll go through different tests depending on your diagnosis.

  • If you have any other conditions, you need to get clearance from your specialist. (If you have heart disease, diabetes, etc)

How to prepare for Deep Brain Stimulation surgery?

Here are some instructions on how to prepare for your DBS surgery day:

  • Continue your healthy diet and exercise routine (if you can).

  • Stop consuming alcohol, and nicotine products.

  • Stop using medications your doctor advised against (blood thinners, NSAIDs, etc.).

  • Make sure you have a caregiver present that can stay with you, and drive you to and from the hospital.

  • If you live far away from the surgical facility, find accommodation for the night before for easier travel (hotel, family, or friends).

  • Start fasting 8 hours before surgery.

  • Take a shower with the soap recommended by your doctor before surgery.

How does Deep Brain Stimulation surgery work?

The surgical procedure is performed in 2 parts. Depending on your surgeon, they can perform these surgeries in one session, or they can give a downtime of 1-2 weeks in between. The first part is the brain surgery. Which can be performed asleep or awake.

Awake surgery: Awake surgery is currently the preferred method. For awake surgery, the patient must be off their medication. The surgery requires using a head frame. It’s performed under light sedation and local anesthesia on the scalp.

Asleep surgery: Asleep surgery is the preferred method for children, patients who are particularly anxious, or patients with severe symptoms who can’t risk being off medications.

  • A stereotactic headframe is placed on the patient’s head. This headframe ensures that the patient’s head is stable throughout the surgery. The headframe also has coordinates on a 3D axis.

  • With the headframe on, a brain CT is performed. With the help of computer software and the coordinates on the headframe, the exact location of the lead placement is determined.
Deep Brain Stimulation Ct Scan Before Surgery
Assoc. Prof. Dr. Mustafa kılıç adjusting the stereotactic headframe for a ct scan before deep brain stimulation surgery
  • A small portion of hair is shaved to make room for the incision.

  • A light sedative and local anesthesia on the scalp is administered for the comfort of the patient. The head frame is attached to the surgical table for stability.

  • A small incision is made on the shaven areas. Then a small part of the skull is removed to access the brain and make room for the electrode caps.

  • A guide is attached to the headframe, and the guiding leads are inserted. 

  • After the guiding leads a microelectrode recording device is used to locate the correct spot for implantation. This device detects the different activity levels in the brain and turns them into sound waves. Each part of the brain has an individual sound wave, which makes it easier to find the exact target area. 
Deep Brain Stimulation Microelectrode Recording
The screen shows the different microelectrode recording sound waves coming from different areas of the brain
  • When microelectrode recording is done, the actual lead is inserted through the guide.

  • After the actual lead is placed, stimulation parameters are tested. The surgical team will ask you to perform some motor function or speech tests with the device turned on and turned off. This will help them determine if the lead is inserted into the correct place, and to check if the stimulation has any unusual effects. This test is not performed for asleep surgery.

  • If the lead is placed correctly, a cap is placed over the lead, and the cables are placed under the skin for the next stage of the operation. The scalp is closed.

  • 1-2 weeks or right after brain surgery, a chest wall surgery is performed to implant the pulse generator.

  • An incision is made behind the ear and on either the collarbone, the chest, or the abdomen to implant the pulse generator.

  • The wires from the electrodes are fed under the skin from behind the ear, to the area where the neurostimulator will be placed.

  • The wires are connected to the neurostimulator, and the device is placed. Incisions are closed.
Lead Insertion During Deep Brain Stimulation Surgery
Assoc. Prof. Dr. Mustafa kılıç is inserting the leads during deep brain stimulation surgery

How long does Deep Brain Stimulation surgery take?

Deep Brain Stimulation surgery takes about 3-5 hours. The first part of the surgery where electrodes are placed in the brain is longer, and the implantation of a neurostimulator to the chest takes way less time.

How long does it take for Deep Brain Stimulation to work?

Deep Brain stimulation works immediately when the device is turned on. The full benefits of the treatment will be apparent once the perfect settings are found. 

The device is turned on during surgery for testing, and 1-2 weeks after the operation. It may take a few programming sessions to find the perfect settings.

How long does Deep Brain Stimulation last?

The effects of Deep Brain Stimulation will last as long as you have the device, and it’s turned on. DBS can be used for long-term symptom management and can improve the lives of patients up to 10+ years after surgery. 

What happens after Deep Brain Stimulation surgery?

1-2 weeks after surgery the doctor or a special technician will calibrate the device. Finding the perfect setting to reduce your symptoms as much as possible will take some time. You’ll start to notice the changes immediately.

When you find the perfect setting, a decrease in symptoms will be noticeable. You’ll be able to go on with your life and perform daily routines like putting on clothes or brushing your teeth by yourself.

Learning about what happens after surgery is just as important as the surgery itself. We have a separate article where we talk about living with DBS after surgery, where we talk about the immediate aftermath of the surgery, and long-term living with the device in detail.

Deep Brain Stimulation Patient After Surgery

What about DBS devices & maintenance?

DBS devices are like pacemakers but for your brain. They come in four parts;

  • A lead with electrodes that are placed in the brain

  • The extension wire that connects the leads to the pulse generator

  • The pulse generator has a battery and sends the stimulation to the brain

  • A remote control that allows you or your surgeon to adjust the device settings

We have a detailed article where we explain what these devices are, what they’re made of, and compare different brands of DBS devices

DBS batteries can be replaced once they run out. Typically, non-rechargeable batteries last 3-5 years, and rechargeable batteries last 15-20 years. We have a full article that answers all your questions about the DBS battery replacement procedure.

Deep Brain Stimulation Device

What is the price of Deep Brain Stimulation?

On average, Deep Brain Stimulation cost is about $130.000 in the United States. As DBS is a continuous treatment, the cost of it will add over time with every battery replacement, or programming visit.

Patients can reduce the cost of this treatment with insurance coverage, or by getting the treatment overseas. To learn more about the cost of DBS, insurance coverage details, and item-by-item price breakdown, you can read our article. 

What are the pros and cons of Deep Brain Stimulation?

Benefits of Deep Brain Stimulation include the following:

  • Highly effective, can reduce symptoms significantly

  • FDA-approved

  • Has a high patient satisfaction rate, and increases quality of life

  • Insurance coverage is widely available for FDA-approved indications (except for DBS as a treatment for OCD)

  • Can be tailored to a patient’s specific needs

  • Significantly reduces the amount of medication the patient has to take

  • Effects can be felt immediately

  • Suitable for long-term (15+ years) symptom management

  • The device can be turned off or removed, making the treatment reversible

Disadvantages of Deep Brain Stimulation are as follows:

  • The surgery is considered invasive and has potential risks and complications

  • The device can malfunction, wires can break, or electrode placement can shift in the long term

  • If you choose a fixed battery device, you have to get battery replacement surgery every 3-5 years

  • Only done in specialty centers

  • Requires constant monitoring and checkups

  • Lifetime costs can add up

  • Insurance policies might not cover costs depending on your diagnosis

  • Doesn’t work for everybody

  • Living with a DBS device can alter your daily activities and routines

How to get deep brain stimulation

You can either get DBS as a form FDA-approved treatment for your illness, or you can get it as an experimental treatment for your treatment-refractory disease.

For diseases such as Parkinson’s, essential tremor, dystonia, OCD, and epilepsy, your doctor can recommend this treatment if you’re not responding to other treatment forms. Then, you can decide, where, when, and how you can get this treatment. You can opt to pay out of pocket, be reimbursed by insurance, or even travel to a different country to receive the DBS  treatment overseas, as long as you get your doctor’s approval.

If you’re interested in DBS as an experimental treatment option for illnesses such as depression, Tourette’s, or cluster headaches, the criteria are way stricter. You should have a severe case, and all other forms of treatment should be ruled out as ineffective. If that’s the case, you can get the treatment as a part of a clinical trial, or you can get it done overseas. If you’re interested, we have an article about what it’s like to get Deep Brain Stimulation in Turkey where we discuss which diseases can be treated. 

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