Deep Brain Stimulation

Some movement disorders don’t adequately respond to medications, requiring more sophisticated therapies.

The multidisciplinary team at UT Southwestern Medical Center uses deep brain stimulation (DBS), a form of neuromodulation, as an advanced treatment for diseases such as Parkinson's disease, essential tremor, dystonia, and other movement disorders.

Peter O'Donnell Jr. Brain Institute

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The Peter O’Donnell Jr. Brain Institute brings together transformative research and patient-centered care to improve the lives of patients today and those of generations to come.

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What Is Deep Brain Stimulation?

Irregularities in the circuitry of the nervous system cause a range of neurological and psychiatric disorders, such as Parkinson’s disease, dystonia, essential tremor, and Tourette syndrome.

Deep brain stimulation (DBS) can help alleviate symptoms and improve daily functioning for many individuals with movement disorders. DBS modulates neural activity in brain networks, improving symptoms associated with abnormal circuitry.

In the DBS procedure, a neurosurgeon inserts a tiny wire (electrode) into the brain to target electrical irregularities and produce a more normal pattern of brain activity. The wire, or lead, is then connected to a neurostimulator device that is implanted near the collarbone. As needed, the device delivers current to nudge the cells in the brain into a regular electrical rhythm.

DBS is not a cure and does not replace continued medical therapy. Even after DBS, patients will take medication to manage their condition. It may take several months to optimize the effects of DBS.

Our multidisciplinary team carefully evaluates patients to determine if DBS therapy is appropriate for them.

Ranked in the top 20 U.S. hospitals for neurology and neurosurgery by U.S. News & World Report, UT Southwestern Medical Center provides leading-edge treatments such as DBS to improve patients’ prognosis and quality of life.

What Conditions Are Treated with Deep Brain Stimulation?

For qualifying candidates, DBS can effectively treat the following conditions:

Parkinson’s disease
Essential tremor, or rhythmic shaking
Dystonia, or involuntary muscle contractions
Tourette syndrome (not FDA approved)

While the effects of DBS on a variety of other disorders are still being studied, research shows that the treatment may also reduce symptoms of the following conditions:

Obsessive compulsive disorder
Schizophrenia
Depression
Dementia
Chronic pain
Obesity
Cluster headaches
Addiction
Chorea, or involuntary movements

How Is Deep Brain Stimulation Used to Treat Different Conditions?

Parkinson’s disease

For patients with Parkinson’s disease, DBS is intended to provide more consistent control of motor symptoms.

The symptoms that can be managed with deep brain stimulation include:

Rigidity (or stiffness)
Bradykinesia (or slowness)
Tremor
Dyskinesias
Dystonias

DBS is most often recommended for patients with:

Motor fluctuations
Disabling off periods
Disabling dyskinesias
Unpredictable response to medications
Dystonias
Medication-refractory tremor

DBS does not improve balance issues, speech issues, cognitive function, autonomic dysfunction, and swallowing function.

DBS is not meant to be a substitute or replacement for medications. Rather, it works as an adjunctive therapy to make the medications work more consistently.

In general, patients should expect to spend more time with the best symptom control they can achieve with medications. Response to medications for Parkinson’s disease is one of the best predictors of how someone will benefit from deep brain stimulation. The one motor symptom that can respond to deep brain stimulation that does not get better with medications in tremor.

Two common targets for deep brain stimulation in Parkinson's disease are the subthalamic nucleus (STN) and the globus pallidus interna (GPi).

Essential tremor

For patients with disabling tremor, DBS is intended to provide significant relief of disabling tremor in the arms and legs (appendicular tremor).

To be eligible for deep brain stimulation, a patient should have tried and failed (or not be able to tolerate) at least two medications, usually including propranolol and primidone although other medications can be tried as well.

DBS is only considered for patients who are disabled by their tremor. The amount of disability does not always directly relate to the amount of tremor, depending on age, work, and desired activities and independence.

While deep brain stimulation can provide some benefit for head and neck tremor, voice tremor, and body tremor (axial tremors), especially when performed bilaterally, it is not primarily intended to treat these symptoms.

DBS will not completely get rid of tremor and some patients continue to take medications even after DBS.

A commonly used target for DBS in treating tremor is ventral intermediate (VIM) nucleus of the thalamus.

Dystonia

Dystonia can present with involvement of different body regions, including generalized (affecting the whole body), segmental (involving two or more contiguous body regions, such as the neck and arm), or focal (affecting one body region, such as cervical dystonia or hand dystonia).

Dystonias are usually managed with medications or targeted botulinum toxin injections. When these therapies do not provide adequate control, DBS may be considered for select patients.

The effectiveness of DBS in treating dystonia depends on the underlying cause and specific body parts affected. Historically, DBS has been been used for generalized dystonias, but is increasingly used for focal/segmental dystonias (for example, cervical dystonias) with high rates of success. A common target for DBS in treating dystonia is the globus pallidus internus (GPi).

What Can Patients Expect During the Evaluation Process and DBS Surgery?

Preparing for DBS involves several steps. If the neurologist determines that a patient might benefit from the treatment, the patient will be evaluated in the Neuromodulation Dual Clinic to find out if they are a good candidate. This clinic involves both neurologists and neurosurgeons and includes a series of consultations and tests. A team member from the neuromodulation team will reach out to go over the specifics for the appointment prior to the visit.

If DBS is recommended after the evaluation, the next steps include:

Imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT) scan, to find the correct coordinates for electrode insertion
Surgical insertion of the electrode under local anesthesia or general anesthesia, depending on clinical and patient needs
Testing the effects of the neurostimulator to confirm whether the treatment improves symptoms or causes side effects
Implanting the neurostimulator near the collarbone under general anesthesia

About the Surgery

DBS surgery occurs in three parts:

Brain surgery (Stage 1):
1. Surgery is usually done while the patient is awake to ensure the best DBS placement.
2. Surgery lasts between two and four hours.
3. Patients usually stay overnight in the hospital.
4. Patients continue their medications, except for aspirin and blood thinners.
“Battery” surgery (Stage 2):
1. The patient is asleep during the procedure.
2. It takes less than one hour and is typically outpatient (patients go home the same day).
After surgery programming
1. Patients initially return for programming adjustments every four to six weeks, and then visits become less frequent.

Our care team will provide complete instructions for cleaning the incisions, monitoring symptoms, and caring for and programming the neurostimulator.

Risks of DBS

Bleeding or stroke (about 1%)
Infection (about 3-4%)
Seizure (1-3%)
General complications related to major surgery: heart, lungs, blood clots, urinary tract infection
Device discomfort
Stimulation-related side effects

Are Clinical Trials Available for DBS?

As a world-class academic medical center, UT Southwestern offers patients unique access to research, clinical trials, and new therapies – often before they’re available at other hospitals.

We’re involved in clinical trials related to DBS. Ask our doctors about which may be appropriate.

Search for clinical trials