Deep Brain Stimulation (DBS) Surgery

What is deep brain stimulation surgery?

Deep brain stimulation (DBS) is a surgical procedure to implant 1 or more electrodes in your brain. The electrodes transmit electrical pulses to specific areas of your brain. These block abnormal brain signals that could be causing various neurological disorders.

How it works

Deep brain stimulation involves small holes in the skull to implant electrodes. During the surgery, you will be kept awake to provide feedback on the areas being stimulated. A separate surgery implants the device containing the battery under the skin below your clavicle and over your chest wall.

Why do you need deep brain stimulation surgery?

Deep brain stimulation surgery is a treatment for:

• Dystonia
• Epilepsy
• Essential tremor
• Obsessive-compulsive disorder
• Parkinson’s disease. This is especially if medication is not sufficient to improve your symptoms.

Deep brain stimulation surgery benefits patients with Parkinson's disease as it:

• Reduces the severity of symptoms such as dystonia (muscle stiffness), dyskinesia (muscle twisting) or tremors.
• Helps you regain control of your movements.
• Preserves your quality of life and independence.

What are the risks and complications of deep brain stimulation surgery?

Deep brain stimulation is a minimally invasive procedure that is considered safe. However, there are some risks from the surgery:

• Infection, or pain and swelling at the implantation site
• Misplacement of leads
• Bleeding in the brain
• Nausea
• Seizure
• Stroke

How do you prepare for deep brain stimulation surgery?

The surgery requires considerable pre-operative planning.

Your doctor will recommend medical tests to make sure that deep brain stimulation is a safe and appropriate option for you.

You'll also need brain-imaging studies, such as an MRI and CT scan before the surgery, to map the areas of your brain to implant the electrodes.

What can you expect in deep brain stimulation surgery?

Deep brain stimulation surgery consists of 2 separate procedures to implant the electrodes and generator respectively. The procedures may be done during the same session or scheduled separately.

Estimated duration

The procedures usually take 4 – 6 hours.

Before the procedures

You will receive different anaesthesia before the 2 procedures:

• Local anaesthesia will be given before your doctor implants electrodes in your brain. This numbs your scalp, protects you from discomfort and keeps you conscious during the procedure.
• General anaesthesia will be given before a generator is inserted within your chest.

During the procedures

You can expect the following when undergoing deep brain stimulation surgery:

Implanting electrodes in the brain

In the first procedure, your doctor will:

• Make small burr holes (drilled holes) in your skull
• Strategically implant electrodes into the identified areas of your brain
• Ask you for feedback to confirm that the correct areas of your brain are being stimulated

Inserting a generator within the chest

In the second procedure, your doctor will carefully insert a battery, called a pulse generator, within your chest.

The pulse generator allows you to regulate side effects and suppress symptoms through a wireless hand-held controller.

After the procedures

Complications and side effects may include:

• Infection
• Headache
• Confusion or difficulty concentrating
• Pain and swelling at the sites where the electrodes are implanted
• Hardware complications (e.g. wiring issues)
• Seizure
• Stroke

A few weeks after the surgery, your doctor will activate the impulse generator to start the stimulation. The amount of stimulation you need depends on your condition. It may take months to find the optimal level of stimulation.

After your device is switched on, you may experience:

• Lightheadedness
• Problems with balancing
• Numbness or tingling sensations
• Muscle tightness in your face or arm
• Vision problems, such as double vision
• Speech problem
• Mood changes

These symptoms often improve with adjustments to the settings.

Your doctor will advise you on the duration of stimulation each day and how to make minor adjustments at home. When the battery runs low, your doctor will replace the generator in an outpatient procedure.

Care and recovery after deep brain stimulation surgery

To allow your surgical wound to heal properly:

• Avoid light activities for 2 weeks
• Avoid carrying heavy things for at least 2 weeks
• Avoid physical activities such as jogging for 4 – 6 weeks
• Avoid strenuous activities until your doctor gives the go-ahead
• Do not raise your arms above your shoulders or overstretch your neck unless your doctor gives the go-ahead.