Deep Brain Stimulation (DBS) Frequently Asked Questions

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UW Health neurosurgeons in Madison, Wisconsin, perform deep brain stimulation (DBS) for selected patients with Parkinson’s disease, essential tremor, tremor and other movement disorders.
 
Is deep brain stimulation (DBS) right for me?
 
Any patient with a movement disorder such as Parkinson’s disease, essential tremor, dystonia, torticollis, spasmodic torticollis, Tourette’s syndrome, other involuntary movements and tremor should consult with a movement disorders neurologist. Often, the movement disorders neurologist can recommend changes in medications that may reduce the need for DBS surgery.
 
The different types of DBS - subthalamic, globus pallidus, thalamic and pedunculopontine nucleus DBS - have strengths and weaknesses. The best way to decide if DBS is the right approach for you is to learn as much as you can about DBS, including which procedures are most effective for your symptoms, and talk to a physician.
 
Whether a patient should have DBS depends on the degree of other neurological or medical problems. For example, patients with significant depression or problems with thinking or memory may have greater risks with DBS surgery. The relative value of DBS should be discussed with the movement disorders neurologist and neurosurgeon.
 
Is deep brain stimulation (DBS) approved by the Food and Drug Administration?
 
The Federal Food and Drug Administration (FDA) approved deep brain stimulation of the thalamus for the treatment of tremor in 1997. Subthalamic DBS for Parkinson's disease was FDA approved in 2002, and globus pallidus DBS was FDA approved in 2003.
 
The approval for dystonia is under a specific condition called a Humanitarian Device Exemption (HDE). This means that DBS for dystonia has not undergone the same extensive studies that were done for tremor and Parkinson's disease. However, there was considerable evidence of its safety and effectiveness for dystonia that the FDA approved it. The Humanitarian Device Exemption by the FDA requires physicians and surgeons to obtain special permission in order to offer DBS for dystonia.
 
While DBS has not been approved by the FDA specifically for the treatment of other conditions, such as tremor due to causes other than Parkinson's disease or essential tremor, physicians and surgeons consider DBS for these conditions safe and effective. The same devices approved by the FDA for Parkinson's disease, essential tremor and spinal cord stimulation for pain are used in DBS surgery.
 
How much improvement will I see?
 
Improvement varies from patient to patient, but most DBS patients experience dramatic improvement (as much as a 70 percent reduction in symptoms).
 
For patients with Parkinson's disease, how well the patient is doing when their medications are working their best, even if momentarily, is a rough indication of how these patients may do following DBS.
 
What are the drawbacks of deep brain stimulation (DBS)?
 
Any surgical procedure has risks. For DBS, most complications can arise from the placement of the stimulator. There is a 2-3 percent chance for permanent or serious complications. The risks may increase depending on the patient's overall neurological and/or medical condition. However, this means that 97 to 98 patients out of 100 are going to do well. It is important to remember that there are risks in not doing DBS surgery and those risks are those associated with the ineffectively-treated symptoms of the patient's disease.
 
What should I look for in a team when considering deep brain stimulation (DBS)?
  • Experience: Neurosurgeons performing DBS surgery should have fellowship training in stereotactic or functional surgery following neurosurgery residency.
  • Intra-operative neurophysiologists: Most experts in the field believe that micro-electrode recording of the extra-cellular action potentials (electrical discharges) of individual neurons by specialists is the most optimal method for DBS target localization. These methods offer the greatest assurance of optimal lead placement. For EMCS, recording of electrical activity from the brain in response to stimulation of nerves in the arm and face as well as test stimulation are critically important for the proper placement of the EMCS electrodes.