Deep brain stimulation (DBS) can be a powerful treatment for brain diseases including Parkinson’s disease, essential tremor, dystonia, obsessive-compulsive disorder and epilepsy. A DBS is a surgically implanted device that delivers electrical stimulation to the brain, similar to the way pacemakers stimulate the heart. Each DBS has three parts, all housed invisibly under the skin:
- A battery, also called an implanted pulse generator or IPG. Usually this is placed near the collarbone
- One or two electrodes or leads, tiny wires that can deliver precise amounts of current to small areas within the brain
- A lead extension, an insulated wire that connects the leads to the battery
After DBS placement surgery, patients return for several outpatient visits to program the pulse generator. This tailors each person’s DBS settings to their needs. The process of adjusting the DBS settings is called DBS programming.
Would DBS Help Me?
Each person’s situation is unique. At Mass General, we generally recommend DBS when non-surgical options no longer adequately control the movement symptoms, and when DBS will likely improve quality of life. Successful DBS provides lasting benefit for many years, although for progressive conditions like Parkinson’s disease it does not slow or cure the underlying disease. We try to learn from each person what their individual goals for DBS are so that we can offer the best estimate of how likely DBS is to achieve those goals.
If you are considering having DBS at Massachusetts General Hospital you will undergo an evaluation process in which you tell us about your symptoms and goals, meet the members of the DBS team and ask any questions you have about DBS. We will also review the risks of DBS surgery. Although serious complications from DBS surgery are infrequent, it is important to understand the risks of permanent side effects, infection or device malfunction requiring device removal or replacement. Usually as part of the evaluation process you will meet:
- A DBS neurologist and DBS nurse practitioner to review your clinical history, learn your goals for DBS, examine your symptoms, and answer your questions
- A DBS neurosurgeon to discuss the surgical procedures, experience, and different approaches to DBS surgery
- A neuropsychologist to assess the impact of your movement disorder on cognition and mood
- Some patients may have voice or swallowing evaluations with our clinical partners at Mass Eye & Ear
What Anesthesia Options Do I Have?
Most patients receive deep brain stimulation systems via two operations. The first operation places your DBS leads in the brain—usually as a pair, with one placed on each side of the brain. In some cases, such as when symptoms are predominantly on one side of the body, only a single lead may be placed. The first operation usually requires an overnight hospital stay for observation. The second operation is a relatively brief day surgery, typically one or two weeks after the first. It places the DBS battery in the chest, and connects it to the brain leads. Patients can have their lead placement surgery in one of two ways. Studies so far show similar outcomes from the two methods, and each patient’s preference is an important factor in determining which method will be used.
- Awake surgery, target guided by brain activity: This is the traditional procedure, chosen by patients who want to minimize general anesthesia or to give feedback on electrode placement. If you choose this approach, you will have light anesthesia for the first part of the surgery, and then local anesthesia of the scalp for the rest of it. This is possible because the brain itself does not feel pain. Being awake for part of the surgery lets the surgeon and DBS neurophysiologist test different potential lead locations, stimulate and directly observe any benefits or side effects, and choose the most effective location. To avoid masking the symptoms that the surgeon will test, you will need to stop taking your movement disorder medications the night before surgery. The awake DBS approach may be preferred when you have symptoms, such as tremor, which are easily and reliably assessed in the operating room.
- Asleep surgery, targeted by MRI imaging: During this newer approach, you will be under general anesthesia throughout the procedure. Instead of electrophysiological guidance of lead placement, the surgery takes place while you are in an MRI scanner that provides a real-time picture of the DBS lead location. You don’t need to stop your movement disorder medications the the night before surgery. This asleep DBS approach may be preferred if you have large-amplitude involuntary movements or severe anxiety.
What DBS Device Choices Are There?
There are now three companies in the U.S. that make DBS devices: Medtronic, Abbott, and Boston Scientific. They offer models that include rechargeable and non-rechargeable batteries, directional stimulation, independent current control, and sensing. You can either leave the device choice to your team, or let us know which features are most important to you. An important factor in device choice is where you will receive follow-up DBS care. Not every DBS center is familiar with all DBS devices, and not all devices are supported internationally. If you are going to continue your DBS care at Mass General, we offer all of the currently FDA-approved DBS device options.
Learn More About Device Models
- Activa RC (rechargeable)
- Percept PC (non-rechargeable, independent current control, sensing-enabled)
- Boston Scientific
- Vercise Genus PC (non-rechargeable, independent current control)
- Vercise Genus RC (rechargeable, independent current control)
- Infinity (non-rechargeable)
Learn More About Rechargeable and Non-Rechargable Systems
- The battery life is 10-15 years before surgical replacement is needed.
- The rechargeable batteries are typically smaller in size and thinner than nonrechargeable ones.
- You can assess your battery’s remaining life using a patient DBS programmer, which will tell you when it is time to schedule battery replacement.
- The replacement surgery is a day surgery and only the battery is replaced, not the wires in your neck or brain.
- Battery life is typically 2-5 years between replacements. The duration depends on your individual DBS settings, with settings that require higher currents leading to shorter battery life.
Other DBS Device Features
Current Steering or Directional DBS
Current steering refers to a DBS lead technology where the DBS lead surface is separated into smaller contacts so that the DBS programmer has more flexibility in choosing which part of the lead delivers stimulation into the brain, allowing the programmer to “steer” the stimulation field to one side of the lead or the other. This may help the DBS programmer direct the stimulation to regions that offer the best benefit and away from regions that cause side effects, resulting in an overall better outcome. All three device manufacturers offer leads with current steering capability, and we implant current steering compatible leads in all cases.
Independent Current Control
Independent current control describes a DBS system that gives the DBS programmer greater control over how much stimulation is delivered to each of the DBS lead contacts. This offers more ability to customize the shape of the electric stimulation field.
While all DBS devices can stimulate brain regions to suppress symptoms, some new devices can also record brain rhythms to guide DBS programming. The best way to use this sensing information is still unknown, and not all patients have brain rhythms which can guide stimulation. One promising direction, currently under investigation, is called adaptive or closed-loop DBS. It may allow devices to automatically adjust DBS settings in real time, the way some heart pacemakers do.
Life with DBS
After your DBS surgery, you will see your DBS neurology team to adjust the stimulation settings and your medications to best control your symptoms. The first programing visit is usually the longest, taking roughly one hour, and subsequent visits are shorter, roughly 30 minutes each. DBS programming usually involves 3 - 5 visits over a 3 - 6 month period. You will also have a DBS patient programmer at home that allows you to check your DBS battery, turn your DBS on and off, and make adjustments to the DBS settings within a safe range that your neurology team sets. Self-adjustments are optional, and can help you fine-tune your settings. Once fully programmed, your DBS settings usually require no major readjustment other than fine tuning adjustments and routine battery checks.
Will DBS Limit My Activities?
The goal of DBS is to help you live a fuller and more physically active life. You may find golf, yoga, running, tennis and other forms of vigorous exercise are easier after DBS. Patients with DBS can shower and swim. Swimming is a great form of exercise and safe for most people with DBS. For any condition like Parkinson’s disease that affects the coordination of complex movements, and especially when symptoms can fluctuate from moment to moment, it is important to swim in a safe environment and with appropriate precautions.
Metal detectors in airports or other public venues will not harm your DBS device, but can, rarely, alter the stimulation delivered by the device. You should inform security that you have a “brain pacemaker” and request a hand pat-down as is commonly done for heart pacemakers. You will also be given a wallet card that identifies your device. Some airports use backscatter X-ray or millimeter wave whole-body imaging machines. These will not interfere with your DBS device and are safe to use normally.
Can I have medical imaging with DBS?
X-rays, ultrasounds, CT scans, and nuclear medicine scans (PET, SPECT, etc.) are all safe with DBS. All currently available DBS systems are MRI compatible to some extent, though there are limitations to the kinds of MRI scanners, study length, and which segments of the body can be imaged. If a part of your DBS system is not functioning correctly, your system may no longer be MRI compatible and you will need to use other approaches to diagnostic imaging. Before you have an MRI scan you should see your DBS neurology team to document that your DBS system is functioning normally, and is set to parameters compatible with the scan you need.
Get to know the people on your DBS team.
- Director, Deep Brain Stimulation Program
- Department of Neurology
- Director, Movement Disorders Fellowship Program
- Director, Collaborative Center for X-linked Dystonia Parkinsonism (XDP) at MGH
- Director, Mass General Brigham Dystonia Clinic at Massachusetts General Hospital
- Associate Professor of Neurology, Harvard Medical School
Lisa Townsend, NP
- Nurse Practitioner
- Director, Functional Neurosurgery
- Charles A. Pappas Associate Professor of Neurosciences, Harvard Medical School
- Visiting Associate Professor of Brain and Cognitive Sciences, Massachusetts Institute of Technology
- Neurosurgical Oncologist
- Associate Professor in Neurosurgery
Nora Daly, MSHS, PA-C
- Physician Assistant
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