Deep Brain Stimulation
Monica Cerutti shares her story, before and after DBS
A patient talks about her personal and challenging journey with dystonia and how her life changed after being treated by Dr. Barba with deep brain stimulation at the UC San Diego Movement Disorder Center.
DBS Therapy for Movement Disorders
Deep brain stimulation (DBS) is a surgical procedure used to treat movement disorders. It was approved by the FDA in 1997.
Medication can help people with movement disorders control symptoms, but over time the effect of medication on symptoms can subside. When movement control becomes more difficult and impedes your lifestyle, it may be time to consider surgical intervention. DBS is recommended for patients on long-term medication to regain movement control and improve quality of life. Studies have shown that patients with Parkinson's disease who have both DBS therapy and medication therapy live longer than patients who are on medication therapy alone. Read more about this research at pubmed.gov.
DBS delivers electrical stimulation in carefully mapped sites of your brain through embedded electrodes, much like a cardiac pacemaker. This low-level electrical stimulation helps the motor networks in the brain synchronize. DBS can help ease the burden of prescription therapy for movement disorders most commonly associated with Parkinson’s disease, essential tremor and dystonia.
First in the Region for DBS
UC San Diego Health System was the first to introduce deep brain stimulation therapy in San Diego, and we have been advancing our knowledge in the treatment of movement disorders ever since. We are the only center offering the frameless DBS technique in the San Diego County. Recently, our team was the first in Southern California to perform DBS using real-time 3d magnetic resonance image (MRI) guidance. Read the press release on MRI DBS.
The Movement Disorder Center at UC San Diego comprises a team of movement disorder specialists – a neurosurgeon, neuropsychologists, a nurse practitioner, and physical, speech and occupational therapists – who conduct an in-depth evaluation before considering patients for deep brain stimulation.
Is DBS for Me?
When evaluating an individual for DBS therapy, our multidisciplinary team of experts considers these criteria:
- Intact cognitive function
People who have dementia have difficulty tolerating the procedure and may have permanent worsening of cognitive function afterwards. People with minimal cognitive impairment may be considered on an individual basis.
- Significant motor improvement with Sinemet
People with Parkinson’s disease whose motor symptoms improve with medication in their “on” state do the best with DBS. DBS therapy improves the patient's control over their "off" medication state bringing it on par with their "on" state. Response to medications is not as important when considering DBS treatment for people with other disorders such as essential tremor or dystonia.
- Confirmed diagnosis
People with Parkinson’s-like symptoms or with uncertain diagnosis do not respond well to DBS therapy.
DBS is best suited for motor symptoms related to:
- Parkinson's disease
- Essential Tremor (ET)
- Tic/Tourette Syndrome
DBS therapy requires hard work and cooperation between the patient, family and the movement disorder team. A person's age, good general health and a realistic expectation on the outcome are critical in achieving success.
People who are in earlier stages of disease and just beginning to lose the ability to perform meaningful activities – despite optimal medical therapy – can benefit greatly from DBS. Unfortunately, DBS cannot rescue someone with end-stage Parkinson's disease, nor is it a cure for Parkinson’s disease.
Before the Deep Brain Stimulation Procedure
At UC San Diego, potential DBS candidates receive two comprehensive evaluations: one while on their current medications, and another off their medications. This allows us to assess what kind of results can be expected and determine if proceeding with DBS is feasible. The team of specialists will also determine what type of DBS procedure is most appropriate.
Candidates undergo a CT scan and MRI of the brain to map activity that can help pinpoint the exact region for electrode placement. In most cases the type of movement disorder plays a major role in choosing a target region of the brain.
At UC San Diego, we perform DBS using a frameless technique. Unlike the conventional stereotactic frame, frameless DBS surgery significantly increases patient comfort.
Traditionally, DBS surgery is conducted while the patient is awake, and under pain management. This approach allows surgeons to continuously monitor the patient’s brain function and to ensure accurate placement of the device.
After local anesthesia is administered, listening electrodes (brain activity monitors) are used to register your brain activity. The neurosurgeon records your brain’s electrical impulses as you perform tasks such as moving your limbs and reading, made easier by the frameless system.
Real-Time MRI DBS
UC San Diego Health System is a national leader in MRI-guided procedure for brain disease. Read more.
Some patients are candidates for MRI-guided DBS. This DBS surgery is performed under general anesthesia so that the patient can sleep during the placement of the DBS electrode(s). By using continuous real-time MRI monitoring during placement of the electrode, the neurosurgeon can see the exact location of the electrode placement. MRI-guided DBS maximizes patient comfort and safety.
A week after the electrode insertion, the patient returns to have the DBS control module surgically embedded. The control module is implanted below the collarbone and wired under the skin to the electrode in the brain. This is a same-day outpatient procedure.
After the DBS Procedure
Results can be dramatic in patients with dystonia, Parkinson’s and essential tremor, with significant improvement to motor function and control over body movements. Our highly qualified team of physical therapists and speech pathologists play a crucial role in post-operative recovery and will help you through rehabilitation.
Programming the brain stimulator involves neurological expertise and close monitoring of symptoms. Techniques like the Lee Silverman Voice Treatment approach and neuromuscular electrical stimulation will strengthen your mind and body’s resolve to heal, while we work with you to achieve optimal results.
Meet our Rehab Team
Components of the Deep Brain Stimulator
The deep brain stimulator consists of two major components connected by an insulated wire that is concealed under your skin.
The DBS electrode, about the width of a single strand of spaghetti, is inserted with a guidance catheter through a small opening in the skull into a pre-determined part of the brain.
Depending on the your condition, this could be the:
- Thalamus (VIM)
- Subthalamic nucleus (STN)
- Internal globus pallidus (GPi)
The control module of this electrode (consisting of a battery and circuitry) is implanted under the skin just below the collarbone. This is linked to the electrode embedded in your brain with a concealed insulated wire.
The battery life is 3-5 years. Replacing it is an outpatient procedure that can be done in any surgical center in the United States.
Medicare and most private insurers cover the deep brain stimulation procedure.