How is the DBS device placed?

The way a deep brain stimulation (DBS) device is placed can vary depending on the surgeon and the epilepsy center where it is done. Special types of magnetic resonance imaging (MRI) and a computer navigation system are used to place the electrode in the exact “target” position deep in the brain.

DBS surgery usually occurs in two parts. Sometimes both stages are done with one trip to the operating room. In other cases, stage one and stage two are done separately. For each stage, a person will typically spend 1-2 days in the hospital.

  • Placing DBS electrodes: This procedure can be done with local or general anesthesia. The neurosurgeon and epilepsy doctor will decide which way is best for you. In the operating room, a small hole is made in the skull. The electrodes are placed through this hole into the target area in the brain.
  • Placing the neurostimulator device: This part is usually done under general anesthesia. The device is placed under the skin in the upper chest. A lead (tiny wire) is passed under the skin in the neck and scalp. This wire is then connected to the brain electrodes.
  • During surgery, your EEG (electroencephalograph) may be monitored to see how you respond and to make sure the electrodes are placed correctly.

How is the DBS programmed?

After surgery, the DBS neurostimulator device will be turned on by your doctor or nurse. The device is programmed with a small hand-held computer.

  • The computer adjusts the amount of electrical impulses your brain will receive and how often the stimulation will happen.
  • It may take several weeks to find the best level of stimulation as every person responds differently to DBS.
  • Your nurse and doctor will monitor how you are doing very closely. It’s important for you to report any new symptoms, as well as any change in your pattern of seizures.
  • Once a good level of stimulation is set, you also will be given a programming unit to take home to help you adjust the device if needed and to help you track your seizure activity.
  • Regular follow up visits are needed to monitor how well the DBS works.
  • The neurostimulator device battery will need to be replaced about every few years.

What are the most common side effects of deep brain stimulation?

Side effects can happen for any type of medical or surgical treatment. Not everyone has side effects.

Side Effects from Surgery

Side effects from surgery to implant or place the electrodes and neurostimulator device might include

  • Temporary pain and swelling at the surgery sites
  • Headaches
  • Confusion
  • Rarely, difficulty with the implanted electrical hardware

Side Effects of Programming and Stimulation

Brain stimulation can sometimes cause temporary side effects. These may include

  • Sensation of numbness or tingling
  • Difficulty with speech
  • Dizziness
  • Balance problems
  • Mood changes (depression)
  • Tight muscles in your face or arm
  • Seizures
  • Memory problems

What are the risks of DBS?

All surgical procedures carry some risk. Studies published in the journals Neurology and Seizure show DBS is considered to be generally safe.

Risks of DBS surgery are low and include

  • Bleeding
  • Infection
  • Headaches
  • Nausea
  • Seizures
  • Breathing problems
  • Heart problems
  • Stroke

Does the DBS device ever need to be removed or replaced?

  • The neurostimulator device battery will need to be replaced every few years.
  • In most cases, if DBS doesn’t help improve seizures after two years, your doctor may recommend turning the stimulator off. The neurostimulator device can be removed, but the brain electrodes usually are not removed. Your epilepsy team will continue to work with you to find other treatments to help you control your seizures.

Resources

Find an epilepsy specialist to help you explore this, and other, treatment options.

The DBS® System is manufactured by Medtronic. Additional information for patients and physicians is available on their website.

Authored By: 
Elaine Kiriakopoulos MD, MSc
Authored Date: 
09/2018
Reviewed By: 
Mohamad Koubeissi MD and Patty Osborne Shafer RN, MN
on: 
Saturday, September 15, 2018