Deep brain stimulation (DBS) is a surgical treatment in which a device called a neurostimulator delivers tiny electrical signals to the areas of the brain that control movement.

The DBS system consists of three parts:

• A thin, insulated wire called a lead, or electrode that is placed into the brain
• The neurostimulator, similar to a heart pacemaker, which is usually placed under the skin near the collarbone, but may be placed elsewhere in the body
• Another thin, insulated wire called an extension that connects the lead to the neurostimulator

DBS requires surgery to correctly place each part of the neurostimulator system. DBS in adults usually involves two separate surgeries.

Stage 1 is usually performed under local anesthesia, meaning you are awake but pain-free. (If the procedure is done in children, general anesthesia is given.)

• Your head is placed in a special frame using screws to keep it still during the procedure. Numbing medicine is applied where the screws contact the scalp.
• Numbing medicine is also applied to the scalp at the site where the surgeon drills a small opening in the skull and places the lead into a specific area of the brain.
• If both sides of the brain are being treated, the surgeon will make an opening on both sides of the skull, and two leads will be inserted.
• The surgeon may need to send small electrical impulses over the lead to make sure it is connected to the area of the brain responsible for the patient’s symptoms. Different neurological tests may be done.

Stage 2 is done under general anesthesia, meaning you are asleep and pain-free. The timing of this stage of surgery depends on where in the brain the stimulator will be placed.

• The surgeon makes a small opening, usually just below the collarbone and implants the neurostimulator. (Sometimes it is placed under the skin in the lower chest or belly area.)
• The surgeon makes another small opening behind the ear and passes the extension wire under the skin of the head, neck, and shoulder.
• The extension wire connects the lead to the neurostimulator.
• The skin is closed, and the device and wires cannot be seen outside the body.

Once connected, electrical pulses travel from the neurostimulator, along the extension wire, to the lead, and into the brain. These tiny pulses interfere with and block the electrical signals that cause tremors and movement disorder symptoms, such as those that occur with Parkinson’s disease, essential tremor, or obsessive-compulsive disorder.

This surgery may be an option for patients with very severe Parkinson's disease symptoms that cannot be controlled by medications. The surgery does not cure Parkinson’s disease, but can help make reduce the severity of symptoms such as:

• Tremors
• Rigidity
• Stiffness
• Slow movements
• Walking problems

Deep brain stimulation may also be used to treat the following conditions:

• Essential tremor
• Dystonia
• Arm tremors related to multiple sclerosis
• Tourette syndrome (in rare cases)
• Obsessive-compulsive disorder