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 in one admission. 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. This process will vary based on surgical centers.

  • Placing DBS electrodes: This procedure is most often done under general anesthesia. In the operating room, a small hole, about the size of a dime, 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 also performed under general anesthesia. The device is placed under the skin in the upper chest or in the abdomen. 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 tablet computer.

  • The computer adjusts the amount of electrical impulses your brain will receive and how often the stimulation will happen.
  • It may take several months 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.
  • You will receive a patient programmer, a smartphone like device, to provide you with some control over your therapy as determined by your clinician. Some examples provided may be turning on/off your neurostimulator, checking your device life, making changes to your therapy, or marking different events set by your doctor.
  • Your clinician may set up the device to track events between clinic visits to gather information about your symptoms and seizures. This information may be helpful to them to make decisions about your treatment. With the new Deep Brain Stimulation device, the system may also be set up to get information from the leads on brain activity that may align with your symptoms.
  • Regular follow up visits are needed to monitor how well the DBS works, but over time these may occur less often.
  • The neurostimulator device battery will need to be replaced about every 3 to 5 years, but some patients may need higher or lower settings that impact the life of the device
  • Using the patient programmer, you are able to see your battery life so you can work with your doctor to arrange replacements.

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

  • Sensation of numbness or tingling
  • Dizziness
  • Mood changes (depression)
  • Seizures
  • Sleep disturbances
  • 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 about every 3-5 years depending on your stimulation levels. However, newer models are likely to have batteries lasting longer time periods.
  • DBS is a reversable procedure
  • 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: 
Stephan U. Schuele MD, MPH
Adriana Bermeo-Ovalle MD
on: 
Wednesday, December 23, 2020