FAQs on deep brain stimulation: What is it? What does OHSU offer?

If you or a loved one has Parkinson’s disease or essential tremor, you may have heard of deep brain stimulation. But what is it? How does it help? And how is it done here at OHSU?

Here are 10 of the most frequently asked questions that can help you learn more.

We’ve also recently launched a new deep brain stimulation website with details on the procedure and which patients make good candidates.

1. What is deep brain stimulation?

Deep brain stimulation, commonly referred to as DBS, is a surgical treatment for patients with Parkinson’s disease, essential tremor and other disorders. It works like a pacemaker for the brain. Tiny electrodes, or leads, are placed in one or two parts of the brain that control movement. They’re connected by thin wires to a small device implanted just under the skin, usually in the chest.

The device, often called a stimulator, sends low-voltage electrical pulses to the leads, helping the brain control movement.

Colin Halstead of Eugene works as a counselor at a church. Since having DBS surgery at OHSU, he no longer worries about having to go on disability.
Colin Halstead of Eugene works as a counselor at a church. Since having DBS surgery at OHSU, he no longer worries about having to go on disability.

2. Why do people get DBS?

Many patients with Parkinson’s or essential tremor report a dramatic improvement in quality of life.

Patients often need far less medication to control symptoms. They can regain the ability to perform everyday tasks, such as eating and dressing on their own.

Colin Halstead of Eugene, for example, walked with two canes and took 27 pills a day before his DBS surgery at OHSU. His employer thought he needed to go on disability. Now Halstead can walk without a cane and takes one pill a day.

“I would do this again in a heartbeat,” said Halstead, who has Parkinson’s disease. His boss told him: “I would not know you have this disease anymore, from what I can see, unless you tell me.”

3. Is DBS a cure?

No. DBS won’t cure Parkinson’s or essential tremor, and it won’t slow the progression of either disease. The stimulator settings can be adjusted, however, to better control symptoms as changes occur.

4. How is DBS done?

DBS involves two surgeries. Here at OHSU, both are done with the patient under general anesthesia.

In the first surgery, OHSU neurosurgeon Kim Burchiel, M.D., makes one or two incisions in the skull, each smaller than a dime. He uses MRI and CT scans taken before and during surgery to place the leads in the exact spots of the brain.

A study at OHSU showed the technique is exceptionally precise. Most patients spend one night at OHSU Hospital and go home the next day.

In the second surgery, two to seven days later, the stimulator is placed in the chest. The device is about the size of a tea bag. It goes under the skin, usually below the collarbone. The patient goes home that day.

About a week later, the stimulator is programmed using a small device called a programmer. Many patients need several sessions to achieve the best symptom control. After that, the stimulator is typically adjusted every six months. The battery is replaced every three to five years in a minor outpatient procedure.

5. Does DBS help every Parkinson’s or essential tremor patient?

No. In some cases, DBS can make symptoms worse. We thoroughly screen patients to make sure they have a high likelihood of significant benefit. Those who aren’t good DBS candidates are offered other treatments.

6. Are there risks?

Yes. DBS involves surgery, and all surgery carries some risk. With DBS, risks include possible stroke or speech problems.

Risks, however, are generally low. A recent three-year analysis of U.S. academic medical centers, including OHSU, found that among 2,038 patients who had DBS, seventy-two had complications, and one died. Among the 219 patients who had DBS at OHSU, none died and one had complications.

7. How does DBS work?

Colin Halstead, a DBS patient who has Parkinson's disease, is back working in his woodshop.
Colin Halstead, a DBS patient who has Parkinson’s disease, is back working in his woodshop.

Researchers think the electrical pulses change the abnormal signals in the brain that cause tremor and other symptoms.

8. How does DBS differ from other treatments?

Unlike some other surgeries for Parkinson’s or essential tremor, DBS does not destroy brain tissue. That makes it reversible. If something better comes along, DBS can be turned off or removed.

9. How long does DBS last?

Studies show improvements last years. A study published in JAMA Neurology in 2011 found that Parkinson’s patients were seeing significant improvement 10 years after surgery.

In a 2012 study published in Stereotactic and Functional Neurosurgery, essential tremor patients reported significant benefits – whether they had DBS surgery one year before or four years before.

10. What does OHSU offer?

Burchiel, our DBS surgeon, has done DBS more than 1,000 times. He also introduced asleep DBS in 2011, relieving patients of the fear of being awake during brain surgery.

Patients also receive care from our nationally recognized movement disorders program, with experts in physical therapy, speech therapy, psychology and other areas.

In addition, we can treat DBS patients from outside the Portland area. A secure video link enables patients to complete many  appointments from their own communities.

Learn more on OHSU’s DBS website. You’ll find a longer video about Colin Halstead, checklists to see whether you or a relative could be a candidate, and more about the benefits and risks.