William McK. & Marcia N.Thompson Center for Restorative Neurosurgery
Deep Brain Stimulation
Surgical treatment is an option for patients with symptoms inadequately controlled by medication or who are experiencing unacceptable side effects. Surgical treatment can reduce symptoms and improve function, but it is not a cure.
In the late 1950s and 1960s, thalamotomy, which involves surgical destruction of an area of the brain known as the thalamus, was shown to be beneficial in the treatment of tremor. Deep brain stimulation of the thalamus was FDA-approved for the treatment of tremor in 1997, and the subthalamic nucleus in 2002.
Deep brain stimulation, or DBS, involves the surgical implantation of a lead (very fine wire), with four tiny electrodes deep into a part of the brain. This wire is attached to a stimulator, similar to a heart pacemaker, which is placed under the skin of the upper chest below the collarbone. After the stimulator is programmed, the electrical stimulation will override part of the brain, which is making movement difficult. The stimulator may be implanted on one or both sides of the body to help the symptoms. This operation is not a cure; it treats the common symptoms and they will come back when the stimulator is turned off. The operation will take between 4 and 8 hours. During the operation, the patient remains awake. Active participation will be required and involves following simple instructions and describing what they are feeling when asked by the surgical team. A second surgery is done the following week to implant the pulse generators. The major risks, which may occur with this surgery, are a 1-2% risk of intracranial hemorrhage, stroke or death, and a 2-3% risk of infection or breakage of the implanted hardware.
Before you have this operation, it is necessary to make sure that it is the right treatment for you. If we have suggested it, you know that in our opinion you are a possible candidate for DBS. However, we must very carefully assess your condition (with the help of other specialists) before we make a final decision about whether this surgery is entirely appropriate for you and can be done with a high chance of success and low risk of complications.
You will have an evaluation done by Rajeev Kumar, MD, Medical Director, and Kim Martin, RN. This will involve an on/off medication evaluation with testing and videotaping to see how your response is to medication. This will give us an idea of the response you will have to surgery.
You will have an appointment to see a neurosurgeon, who will ensure that you are a good candidate and fit for this surgery. We will send you for an assessment by a neuropsychologist who specializes in patients with your condition. We will ask him/her to assess you before the operation. It is important for us to know how your memory and thinking processes are before this surgery; we would not want you to undergo brain surgery if there is a serious problem with your memory or thinking processes.
You will also have an outpatient rehabilitative evaluation prior to surgery to assess any needs you may have.
Adjusting the stimulators to the optimal settings is complex and requires a lot of time if you have Parkinson’s disease and dystonia. (Programming of essential tremor is not as extensive). You may have an intensive inpatient rehabilitation stay in the hospital for initial programming and drug adjustments. Programming takes many hours each day, requiring you to be “off” your Parkinson's medications. Kim Martin will program you in the hospital and also perform frequent follow-up programming sessions in the office.
Our surgical services include thalamotomy, pallidotomy, and deep brain stimulation of the thalamus, subthalamic nucleus, and globus pallidus.
>>DBS in Photos