Deep Brain Stimulation

Henry Ford has a record of excellence in the surgical treatment of patients with movement disorders. Our Movement Disorders Center was the first in Michigan and the third in the world to perform microelectrode-guided deep brain stimulation (DBS) to treat patients with Parkinson's disease, tremor, dystonia and obsessive-compulsive disorder. This advanced procedure allows patients with Parkinson's Disease to undergo surgery without having a frame placed on their heads and without having to be awake.

Deep brain stimulation therapy: How it works

The DBS system is similar to a heart pacemaker. Surgeons implant a stimulator that delivers mild electrical stimulation to specific areas of your brain through an electrode. Following the procedure, your doctor adjusts the settings to make sure it provides you the most relief possible. Getting the initial settings right for you may take several sessions. As your symptoms change, we work with you to adjust your settings accordingly.

Exactly how DBS improves the symptoms of movement disorders is an area of active research. Most likely, electrical circuits “misfiring” in your brain cause abnormal and uncontrollable movements like tremor. Doctors believe that DBS disrupts abnormal firing patterns and replaces them with regular firing patterns, without removing or destroying parts of your brain.

Will I feel deep brain stimulation therapy?

Most people don’t feel the stimulation at all. Some people may feel a brief tingling during the first stimulation. A few weeks after the procedure, you can go back to your normal daily activities.

DBS procedure: What to expect

The implantation of a deep brain stimulator can be conducted while you are awake or under general anesthesia, utilizing an advanced, MRI-guided technique for placing electrodes.

During the procedure, your surgical team will:

1. Implant the electrode on the morning of the surgery using local anesthetic or while you are under anesthesia, using MRI-guided techniques.
2. Surgically place the DBS into a brain area.
3. Attach the device to an extension wire and a programmable pulse generator.
4. Perform a computed tomography (CT) scan to help pinpoint the exact target locations in the brain.
5. Listen to the brain cells through an amplifier (microelectrode recording) to determine whether the electrodes are in the right place.
6. Sedate you once the testing is completed, so that they can close the skin and remove the frame.
7. Monitor you closely overnight to make sure there is no bleeding around the electrode.
8. Perform another CT or magnetic resonance imaging (MRI) scan to make sure the electrode is in the right place.
9. Discharge you, mostly likely the day after the surgery.

Deep brain stimulation: What are the risks?

In carefully selected and screened patients, DBS is quite safe and effective. As with any surgery, however, there are some risks, including:

• An estimated two to three percent risk of brain hemorrhage
• A small risk of leakage of cerebrospinal fluid, which can lead to headaches or meningitis.
• A small risk of infection, hardware breakage and device failure.

DBS is both adjustable and reversible.

Who can benefit from deep brain stimulation?

The Henry Ford Movement Disorders Center provides a thorough evaluation of every candidate for DBS. This includes appropriate pre-surgical testing from our collaborative team of specialists. You might be a candidate for DBS if you:

• Are under the age of 80
• Are not wheelchair bound
• Do not have dementia or significant psychiatric disease
• Have not found relief from the medicines available to you
• Are healthy enough to undergo a surgical procedure complications

What if deep brain stimulation is not right for me?

If you are not an appropriate candidate for DBS, an alternative procedure such as pallidotomy or thalamotomy may still be possible.

• Pallidotomy is a neurosurgical treatment for Parkinson’s disease. During the procedure, surgeons place a tiny electrical probe in one of the basal nuclei of your brain. We then heat the probe to 176°F for 60 seconds to destroy the small area of brain cells that are contributing to your symptoms. Thalamotomy is a neurosurgical treatment for tremor. Doctors believe that the abnormal brain activity causing the tremor is processed through the thalamus, a small structure within the brain located just above the brain stem.