Deep Brain Stimulation

Deep brain stimulation (DBS) is an advanced form of brain surgery that was developed to treat adults with Parkinson's disease. It has since been used to treat patients, including children, with dystonia, a disorder characterized by involuntary muscle contractions that force certain parts of the body into abnormal, sometimes painful, movements or postures. DBS also can help those suffering from essential tremors, tremors associated with multiple sclerosis and severe depression.

Functioning like a "pacemaker" for the brain, DBS uses electrodes implanted in the brain to send out electrical impulses to areas in the brain linked to disorders. The surgery and electrical impulse treatment do not destroy brain tissue.

When treating Parkinson's disease, for example, the inserted DBS device, called a neurostimulator, sends electrical impulses through a wire into the brain to control the movement center. The stimulation blocks abnormal activity in the brain and relieves patients of tremors, rigidity, slowness of movement, stiffness and may help with other problems associated with their conditions. It does not, however, cure patients of their disorders.

The electrode stimulation can be adjusted as the patient's condition changes.

Procedure

DBS surgery involves putting the tip of a hair-thin wire inside the brain in a special area that controls movement. The patient is awake during surgery to allow the surgical team to assess the patient's brain functions. The small wire is inserted through a small hole in the skull and under the scalp, down to a small device implanted under the collarbone. Local anesthetic is applied to these areas.

While the electrode is being advanced through the brain, the patient does not feel any pain. Most dystonia patients have two implants — one on each side of the brain.

At UCSF, the two implants for dystonia patients are usually placed the same day. For adults, the surgery is done with the patient awake for part of the procedure, but children have it done entirely under general anesthesia using interventional MRI-guided implantation, a technique for DBS that was developed at UCSF.

The most serious potential risk associated with the procedure is bleeding in the brain, which can lead to stroke. Risk of stroke ranges from 1 percent to 3 percent among patients. Infection, which occurs in 3 percent to 4 percent of patients, is another risk. If infection occurs, it is usually not life-threatening, but may require removal of the DBS system.

Conditions

The following conditions are treated with deep brain stimulation:

  • Primary dystonia
  • Secondary dystonia
  • Tremor disorders
  • Chorea
  • Parkinson's disease
  • Other movement disorders

More Information

Dr. Phillip Starr, co-director of the Functional Neurosurgery programs at UCSF, is a pioneer in deep brain stimulation for the treatment of dystonia. Dr. Nalin Gupta, chief of Pediatric Neurological Surgery, also treats children undergoing deep brain stimulation.

 

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Surgical Movement Disorders Center
1635 Divisadero St., Suite 520
San Francisco, CA 94115
Neurology: (415) 353-2311
Neurosurgery: (415) 353-2071
Fax: (415) 353-9060

Our Experts

Philip Starr
Dr. Philip Starr,
neurosurgeon