Deep Brain Stimulation (DBS)

What is Deep Brain Stimulation (DBS)?

DBS is a treatment for Parkinson’s Disease (PD), Essential Tremor, and Dystonia. It can help certain patients better manage their symptoms when medications do not work well enough for a good quality of life. In this treatment, a mild electrical current is used to stimulate an area deep in the brain that controls movement. This stimulation changes the activity of the brain cells in a way that helps relieve the symptoms.

The electrical stimulation comes from a DBS system, which is implanted in the body during surgery. DBS has been proven to be effective and safe for the treatment of Parkinson’s Disease and other movement disorder symptoms for those patients who are carefully selected. DBS cannot cure these conditions or change the progression of the disease, but it can help relieve symptoms and improve quality of life.

What symptoms can be helped with DBS?

DBS is recommended for patients with disabling symptoms of PD, including:

  • Tremor: Uncontrolled, rhythmic shaking of the arms, legs, face, or head
  • Rigidity: Stiff or inflexible joints in the arms and legs
  • Slow movements

DBS may also help if you have problems related to PD medications that interfere with daily activities, such as:

  • Dyskinesia: Uncontrolled, irregular, writhing movement
  • Motor fluctuations: Frequent or sudden ‘OFF’ periods when your medication does not control your movement symptoms.

How does DBS work?

You will have surgery to put the three parts of the DBS system inside your body. This is done by a Neurosurgeon. The parts of the DBS system are shown in the diagram below:

Several weeks after surgery, the Internal Pulse Generator (IPG)/Neurostimulator is turned on.

  • The IPG creates electrical impulses and sends them up along the extension wires to the electrodes.
  • The tip of the electrodes delivers the electrical impulses to the target area in your brain. This stimulates the target area without damaging the brain.

The IPG is programmed to give you the best results.

  • This means adjusting the electrical impulses to the setting that best relieves your symptoms with as few side effects as possible.

What are the main target areas for DBS?

The target areas for DBS are small parts of the brain involved in making and controlling movements. The three main target areas are shown in the diagram below.

Your DBS team will:

  • Tell you which target area is best to relieve your PD symptoms.
  • Discuss the benefits and side effects you may expect.

Benefits

  • DBS surgery can relieve specific PD symptoms, depending on the area of the  brain that is stimulated.
  • With fewer symptoms you can move better, do daily activities more easily, gain independence and enjoy a better quality of life.

Side effects

  • Side effects of DBS surgery vary, depending on the area of the brain that is stimulated. Your neurologist, neurosurgeon, and neuromodulation nurse will review potential side effects with you
  • Many side effects can be avoided or reduced by adjusting the settings of your DBS system.

Deciding if DBS is right for you

Each person with PD is unique and DBS cannot help all of them. Your health care team will help you decide if DBS is a good option for you. Generally, the patients that benefit the most from DBS are those which:

  • Have PD symptoms for at least five years
  • Have “on/off” fluctuations
  • Have a good response to PD medications, especially carbidopa/ levodopa
  • Have tried other PD medications without beneficial or sufficient results
  • Have PD symptoms that interfere significantly with their daily activities

To gather the information needed to make this decision, you will have tests and appointments with members of the health care team. This is the screening assessment.

Your DBS Assessment

The screening assessments you have will depend on the reason for your DBS surgery. There will be multiple appointments.

Please bring a family member or support person to all your appointments.

We welcome your questions. We encourage you, your care partner, and family to write down any questions you have and bring them to your appointments.

The DBS Health Care Team

Neurologist and Nurse

  • Evaluate you before and after the surgery.
  • Monitor and adjust your stimulation and medications after you have surgery.

Social Worker

  • Evaluate your emotional and social supports related to DBS surgery and follow-up
  • Discuss your goals and expectations for surgery

Neuropsychologist

  • Evaluate you before the surgery, and if required, after surgery.
  • Evaluate your brain function and check that there is no mental health condition that could worsen with DBS.

Psychiatrist

  • If needed, to evaluate you before and after the surgery.

Neurosurgeon and Neuromodulation Nurse

  • Evaluate you before the surgery and take care of you during the surgery.
  • You will see your neurosurgeon after surgery and when your IPG need to be changed.

The DBS Assessment

Preparing for each of your DBS Assessments:

  • Try to have a good night’s sleep so that you feel rested.
  • Take your medications as usual (unless told otherwise)
  • Bring your glasses, if needed
  • If you wear hearing aids, please make sure to wear them for your assessments

DBS Neurological Assessment

During this visit, the doctor or nurse will:

  • Assess your PD symptoms to see how much your body and movements are

affected.

  • Discuss your goals and expectations for surgery
  • Discuss the factors that help determine whether surgery is the right treatment for you.
  • The neurological assessment will take about 1.5-2 hours.

Medication Challenge Test

To prepare for this test:

  • Do not take any PD medications for about 12 hours before the test.
  • You will receive a letter with the instructions once the test is booked.

During this test, one of the nurses will:

  • Assess and videotape your symptoms before taking Levodopa (OFF time) and after taking Levodopa (ON time).

This test shows how severe your symptoms are and how they respond to Levodopa. This information helps the health care team to better predict how you may respond to DBS.

The medication challenge will take about 2 to 3 hours.

Magnetic Resonance Image (MRI) of the brain

  • MRI uses a strong magnetic field to create detailed images of your brain. These images help the health care team make decisions about the best treatment and plan the placement of electrodes.
  • A recent MRI of your brain is most helpful. We may accept results from an MRI done in the last 1-2 years.

Social Work Assessment

During this visit, the Social Worker will:

  • Talk to you about the impact of your condition on your quality of life and day-to-day functioning
  • Discuss your support systems and how you deal with the challenges you face
  • Evaluate the emotional, social, and environmental factors in your life that may be impacted by DBS treatment
  • Work with you to understand your expectations and goals for DBS treatment.

Ongoing Follow Up:

  • Social Work will be available to patients of the MIND Clinic and the DBS program for ongoing emotional support, advocacy, and help accessing required resources as needed.

Neuropsychological Assessment

This assessment will occur over at least two visits lasting a few hours each and will include:

  • Tests of your memory, problem solving, concentration, perception, language, and other cognitive functions.
  • You will be asked to do tasks such as answering questions, copying, writing things down, naming objects, etc.
  • A discussion about your goals and expectations for surgery
  • An assessment of your mental health and the potential risk of developing problems such as depression or anxiety after DBS surgery. If needed, you could be referred to a psychiatrist or therapist to obtain treatment before getting DBS.

You will receive feedback about your performance on the neuropsychological tests.

If needed… Psychiatric Assessment

  • During this visit, the Psychiatrist will assess your mental health and the risk of developing problems such as depression or anxiety after DBS surgery.
  • The Psychiatrist will tell you if you are at risk and give you recommendations for treatment if needed.

Results of the DBS Assessment and Next Steps

After your assessment is done, the DBS team will:

  • Review the results of your assessments
  • Discuss whether your condition and needs can be helped with DBS surgery
  • Discuss what type of surgery would suit you best
  • Refer you to the DBS Neurosurgery team

FAQs

During DBS surgery, electrodes are implanted in specific areas of the brain that are involved in the condition being treated. These electrodes are connected to a neurostimulator, which is implanted under the skin in the chest. The device sends electrical impulses to the brain, helping to modulate the targeted symptoms.

DBS surgery is primarily used to treat movement disorders such as Parkinson’s disease, essential tremor, and dystonia – a movement disorder that causes involuntary muscle contraction. It is also being explored for the treatment of other conditions like epilepsy, obsessive-compulsive disorder, PTSD, and major depressive disorder.

The modern era of DBS surgery began when the technique was first published in 1987. It was approved in the US for the treatment of essential tremor and Parkinson’s disease in the 1990s and in Canada in the early 2000s. It is now a well-established treatment option for several neurological conditions.

Eligibility for DBS surgery typically depends on the specific condition being treated. Generally, candidates are patients who have not responded adequately to medication or other treatments, have a good overall health status, and do not have significant cognitive impairment, dementia, or psychiatric disorders.

The assessment for DBS surgery is comprehensive, ensuring that the treatment is appropriate for the patient. Potential candidates will meet with the DBS interdisciplinary team, including a neurologist, neurosurgeon, neuropsychologist, social worker, and registered nurses. The goal is to understand the patient’s medical status, cognition, mental and emotional health, and social supports to ensure patients are medically and psychologically prepared for the surgery.

Risks of DBS surgery include infection, bleeding, stroke, and hardware complications. Potential side effects may include speech or vision problems, balance issues, and mood changes. However, these risks are relatively low, and many patients experience significant improvements in their symptoms.

DBS surgery has been shown to be highly effective for many patients, particularly those with movement disorders who have not responded well to medications. It can significantly reduce symptoms and improve quality of life, making it a valuable option when other treatments fail.

Recovery time varies, but most patients can expect to stay in the hospital for a day after surgery. It may take several weeks to recover fully, and there are regular follow-up visits to adjust the device settings. Patients can usually return to normal activities within a few months.

Advances in imaging techniques, surgical navigation, miniaturization of medical devices have significantly improved the precision and safety of DBS surgery. Innovations in neurostimulator technology have also enhanced the ability to customize treatment for individual patients.

Recent innovations include closed-loop systems that adjust stimulation in real-time based on brain activity, and more refined electrode designs that target specific brain areas with greater precision. These advancements are making DBS more effective and reducing side effects.

The Moncton Hospital is the only hospital in New Brunswick offering the surgery, but we will be working with neurologists and other specialists from across the province.

Currently, The DBS program is approved for 11 surgeries per year.

With funding from the government and the Friends Foundation, The Moncton Hospital has invested in state-of-the-art surgical equipment, trained specialized medical staff, and established comprehensive pre- and post-operative care programs to ensure we can meet the demand for DBS surgery effectively.

Our surgeons and medical staff have undergone extensive training in neurosurgery, including specialized training in DBS procedures. They regularly participate in continuing education and professional development to stay current with the latest advancements in the field.

Horizon locations offering this service:

Facility Name Address Phone
The Moncton Hospital 135 MacBeath Ave., Moncton, New Brunswick, E1C 6Z8 506-857-5111