For carefully selected patients with Parkinson’s disease, Essential Tremor, and Dystonia, deep brain stimulation offers a therapeutic surgical option that can reduce or eliminate movement-related problems and greatly improve quality of life. At the University of Michigan Health System, our STIM (Surgical Therapies Improving Movement) program brings together a team of medical experts who are leaders in their respective fields and on the cutting-edge of the latest research.
What is Deep Brain Stimulation or DBS?
Deep brain stimulation, or DBS, is often described as a pacemaker for the brain. It works much like a pacemaker, sending electrical signals to the brain instead of the heart. DBS is primarily utilized for patients who have Parkinson’s disease, dystonia, or essential tremor, and who can’t adequately control their disease with medication. Before any patient is considered for the surgery, they are evaluated by the U-M interdisciplinary team. That team includes a neurosurgeon, neurologist, clinical neuropsychologist, speech pathologist, social worker, and other team members who ensure that you and your family understand the procedure and discuss your expectations and concerns.
It’s important to understand that DBS does not offer a cure for your disease, but a way to manage it more effectively. It can offer many benefits, including the need to take less medication and therefore experience fewer medication side effects.
Deep Brain Stimulation Surgery and Implantation
DBS consists of two surgeries, spaced approximately three to six weeks apart to ensure the patient has adequate time to recover. Throughout your experience, you will be attended to by a top team of physicians and other medical experts including a neurosurgeon, an electrophysiologist, and an anesthesiologist.
- Stage one. During this surgery, electrodes are implanted into specific areas of the brain. Our experts will use an MRI (magnetic resonance imaging) scan to map the brain and to identify the areas where the electrodes will be placed. You’ll be awake during the entire procedure. That way, you can respond to the neurologist and other members of the medical team, who will be performing specific tests to make sure the electrodes are placed in the optimal locations. U-M is also one of the few hospitals in the country where a speech pathologist will be in attendance to monitor you during the procedure. One of the known side effects of DBS is speech problems. At U-M, we pride ourselves on having a low rate of speech side effects in patients because of this monitoring. Most patients require only an overnight hospital stay after the procedure.
- Stage two. During this stage you will have the pulse generator, or “brain pacemaker,” implanted under the skin in your chest area, near the collarbone and connected to the electrodes placed during stage one. You will be under general anesthesia for the procedure. Your physician will implant the generator and attach the lead. The surgery is normally very well-tolerated and is usually performed on an outpatient basis.
It should be noted that DBS offers many benefits. The generator can be programmed by a neurologist, and customized to each individual patient. The procedure is also reversible. Most patients experience a significant improvement of symptoms. However, as with any brain surgery, there are risks. With DBS, the risk of stroke is 1 in 100 and infection is 1 in 50.
Today, many more patients could be helped by DBS than are currently benefiting from the procedure. Statistics show only 7 percent of Parkinson’s disease and 1 percent of tremor patients in Michigan who would benefit from the procedure have undergone DBS. At U-M, we are proud to have one of the superior DBS programs in the country. We have developed a wide array of ways to improve DBS, including special imaging tools that help doctors more accurately place the electrodes, and lead intraoperative motor and speech testing that result in fewer side effects for the patient.
U-M is also home to an active research program, where our team of experts is always working on ways to make DBS faster and more accurate. We also regularly have clinical trials available for patients interested in participating.