Surgical Movement Disorder Clinic

The Surgical Movement Disorder Clinic provides the following:

  • Comprehensive Deep Brain Stimulation (DBS) Evaluations
  • Surgery for Parkinson’s disease, Dystonia, & Essential Tremors
  • Deep Brain Stimulation Programming
  • Deep Brain Stimulation Battery Replacements
  • Baclofen Pump Therapy for Spasticity

Common FAQ Regarding Deep Brain Stimulation

What is deep brain stimulation?

Deep brain stimulation, or DBS, is a treatment that can dramatically improve many symptoms of Parkinson’s disease, including tremors, stiffness, and slowness of the arms and legs. Deep brain stimulation can also provide significant relief to patients with essential tremors and dystonia (abnormal muscle contractions).

Does deep brain stimulation involve taking medications or drugs?

No. Deep brain stimulation is a treatment that does not involve taking more medication. In fact, after deep brain stimulation, many people are able to decrease the amount of medications they take each day.

What type of device, or implant, delivers the deep brain stimulation?

The implanted deep brain stimulator system is similar to a heart pacemaker.

implanted deep brain stimulator system

There are three main parts to the device:

  • The lead, also called the “electrode,” is made of small wires that can carry and deliver electricity.
  • The extension is a larger wire that connects the lead(s) to the battery.
  • The battery, also “neurostimulator” or “IPG,” is the electrical power source. The battery is usually implanted under the collarbone in the chest.

How does deep brain stimulation work?

First you need to understand the source of your symptoms. When you experience symptoms of tremor, stiffness, slowness, or any abnormal movements, the source of these problems is actually not in the muscles themselves but in the brain! Science has shown that bad, or abnormal, electrical brain activity is the reason you experience Parkinson’s disease, tremor, or dystonia.

This irregular, or abnormal, brain activity can be fixed by very small, safe amounts of electricity delivered directly into the brain itself so that it starts working more normally. This is why deep brain stimulation (DBS) is sometimes referred to as a “brain pacemaker.” Like the heart, the brain will start working better when it receives small, regular pulses of electricity through the DBS system.

DBS System

Is the electricity that is being sent into my brain harmful?

No. The electricity delivered by the DBS system is a very small amount and is NOT harmful to your brain or any other part of your body. No bad long-term side effects will occur in your brain due to the use of deep brain stimulation. DBS is a reversible therapy and can be turned off and/or completely removed if an alternative treatment or cure becomes available for your disease. DBS does not cause permanent damage to the brain tissue.

Am I a candidate for deep brain stimulation?

You may be a candidate for DBS treatment if:

  • Your Parkinson’s disease (PD) medication still allows you to move well when you are “on,” but the good effects do not last as long as they used to. You experience a “wearing off” of your medication before the next dose, and sometimes this can happen very suddenly, making it hard to socialize, work or leave your house.
  • After you take your Parkinson’s disease medication, you experience abnormal movements of your arms and legs, known as dyskinesias.
  • Despite taking Parkinson’s disease medications, your tremor is still very bad and interferes with your daily life.
  • You have Parkinson’s disease but you are unable to tolerate medication due to nausea, or other side effects.
  • You have essential tremor that is interfering with your basic living activities, like eating and dressing yourself, and it is not adequately controlled with medications.
  • You have a primary form of generalized dystonia (for example, DYT1) that has not achieved adequate relief with botox or medical therapy.
  • You have cervical dystonia/torticollis that has not achieved adequate relief with botox or medical therapy.

What specific symptoms get better, and what does not, with deep brain stimulation?

In general, your motor symptoms will get better, including:

  • Tremor
  • Stiffness, or rigidity
  • Slowness, or bradykinesia
  • Dystonia, or abnormal muscle contractions

In addition, DBS may:

  • Increase your daily “on” time by up to 5 hours a day (in PD patients)
  • Allow you to decrease your medications
  • Help decrease the abnormal twisting movements known as dyskinesias

Unfortunately, DBS does not typically help with the following Parkinson’s disease symptoms, including:

  • Sudden stopping during walking with difficulty getting started again (“Freezing”)
  • Being off balance
  • Speech and swallowing problems
  • Problems with thinking or memory
  • Depression or sadness

A good “rule of thumb” for deep brain stimulation therapy in Parkinson’s disease is that it will give you the same amount of relief as your medication does during your best time of the day—except that DBS will not “wear off” or lose effectiveness like medication.

Please click below to view videos of how DBS has helped local patients with Parkinson’s.

Video 1
Video 2

What is the surgery like for deep brain stimulation?

To be a surgical candidate, you must first go through our evaluation process. Please click here for a visual overview. This process usually takes 2 to 3 months. While this may seem long, the process is in place to protect you and make sure safe decisions are being made that will truly help you in the long-term. Once the evaluation is done and you would like to go forward with the DBS surgery, we will schedule you for a surgical date. The implantation of the entire DBS system actually occurs in 2 stages, or 2 separate surgeries:

Stage I: The DBS lead is implanted into your brain during this surgery. This type of surgery can be done in the regular operating room (OR) or in the MRI at Willis-Knighton North Hospital.

You will typically stay in the hospital for about 2 days after this first procedure. You will then be discharged to your home.

Stage II: The extension wire will be placed in your neck and the battery in your chest 1 to 2 weeks after the brain surgery during a smaller outpatient surgery under general anesthesia. You will be able to go home on the same day as this surgery.

View Our Evaulation Process

What is the difference between the DBS brain surgery in the regular operating room and DBS brain surgery in the MRI?

DBS in the regular operating room is the traditional, or older, way of performing this procedure. For this type of surgery, patients must stop all of their medications the night before surgery. Patients are lightly sedated during the beginning and the end of the surgery but are awake and speaking with the doctors in the middle of the surgery so certain symptoms, like tremor, can be tested. This more traditional type of surgery is still used in particular cases at the surgeon’s discretion but it has largely been replaced by DBS in the MRI.

DBS in the MRI, also called “asleep DBS,” is a newer type of surgery that works well for most patients, including those with dystonia, severe tremors, or Parkinson’s disease. The majority of Parkinson’s patients become immobile and psychologically stressed when off medications and may find it difficult or painful to stop medication the night before surgery. When you have DBS in the MRI, you may take your usual medications on the morning of surgery. You will also be under general anesthesia with a breathing tube in place for this entire procedure. There is no part of this surgery where you need to be awake and speaking with the doctors. You sleep the entire time, and we wake you up when the surgery is all over.

Generally speaking, we will advise you on which method is best for you, taking into consideration your personal preference and your overall disease state.

What happens after the surgeries? How is the DBS in my brain controlled?

After you have had the entire DBS system implanted, you will be allowed to heal at home for about 2 to 4 weeks. Following this healing period, you will come back to see us in the Surgical Movement Disorders Center. You will see a physician or an advanced practitioner who will turn on the DBS pacemaker and program its electrical settings to give you the best relief of your symptoms. This visit typically takes 1 to 2 hours.

The physician or an advanced practitioner programs your DBS system using a special handheld device that can “talk” to your battery through the skin. This device, also called a programmer, is NOT painful. In addition, we will give you your own handheld programmer so you can change your DBS settings as needed to get the best possible improvement while in your own home.

DBS Controller

You may need to return to our Surgical Movement Disorders Center every few months after surgery so we can check and adjust your DBS settings. It is important to keep your follow-up appointments and to have patience during this process. It may take time to figure out the best DBS electrical settings for your particular disease. Eventually you may only need to see us once or twice a year for a check-up to make sure your DBS system is still working well.

How long does DBS therapy last?

Deep brain stimulation therapy can significantly improve your motor symptoms for 5 to 10 years and even longer in many patients. The battery in your chest needs to be replaced every 2 to 6 years in the majority of patients depending on your particular settings. Battery replacement is done during a short outpatient surgery and involves opening the old chest incision and changing out the old battery with a new one while you are under anesthesia.

What are the risks and side effects of deep brain stimulation?

The major risks of deep brain stimulation therapy include:

  • 2% risk of bleeding or stroke in the brain
  • 5% risk of device breakage, wound erosion or malfunction, requiring repair or replacement of the DBS system
  • 5-7% risk of infection of the DBS system requiring antibiotics, more surgery to remove the device, or both

Fortunately these problems occur infrequently and, when they do occur, people usually still recover over the next several months.

Other side effects that can occur due to the electricity that the device is delivering to the brain include:

  • Making your speech slightly softer
  • Mild numbness or tingling in your face, arm, or leg
  • Slight muscle twitching in your arm or leg
  • Double vision
  • Dizziness

If you experience any of these side effects, we can usually change the electrical settings on the DBS system to make them go away.

I have seen the Surgical Movement Disorder Center and am scheduled for surgery. What should I do to prepare for DBS surgery?

You will receive a preoperative packet with further information and instructions prior to your surgery date. You will also have a clinic visit with a physician or an advanced practitioner during the week before your surgery to answer any questions and prepare you for what to expect during and after surgery.

Click here for Step-by-Step Instructions for your DBS Surgeries and Related Clinic Visits.

If I had my DBS placed at another institution and need a battery change or want to discuss further programming options, can I been seen at the Surgical Movement Disorder Center?

Yes, of course! We are happy to perform DBS programming and DBS battery replacements, even if your initial deep brain stimulation surgery was performed somewhere else. We will also communicate any DBS procedures or programming changes with your original neurologist and neurosurgeon, unless you request otherwise.

Do you have any additional educational materials that I can print out or look at?

Yes. Please click on the resources below that are specific to your particular disease or question:

Deep Brain Stimulation