An Advanced Therapy for Movement Disorders

If you have a movement disorder–such as Parkinson’s disease or essential tremor–an advanced therapeutic surgical treatment called Deep Brain Stimulation (DBS) may offer relief and improve your quality of life.

DBS is used for movement disorders when medications have become less effective or if their side effects interfere with a person’s daily activities or quality of life. For more information or a second opinion, call (585) 922-4111.

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What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a surgical procedure used to regulate the symptoms of patients with movement disorders. During the procedure, small wires (electrodes) are implanted in the brain which deliver electrical impulses that alter abnormal activity that cause movement-related symptoms.

Who is a candidate for DBS?

You may be a candidate for DBS if you have:

• a movement disorder with worsening symptoms (tremor, stiffness) and your medications have begun to lose effectiveness.
• troubling "off" periods when your medication wears off before the next dose can be taken.
• troubling "on" periods when you develop medication-induced dyskinesias (excessive wiggling of the torso, head, and/or limbs).
• movement-related symptoms that interfere with daily activities.

It is important to note that not all patients with movement disorders are candidates for DBS treatment and DBS surgery is not recommended for all people living with Parkinson’s disease or other movement disorders. The expert neurologists in our Movement Disorders Program will help determine if you are a good candidate for DBS.

How is DBS used to treat movement disorders?

Movement-related symptoms of Parkinson’s disease and other neurological conditions are caused by disorganized electrical signals in the areas of the brain that control movement. DBS delivers electrical impulses to a targeted area of the brain, interrupting the irregular signals that cause tremors and other movement symptoms.

How is DBS performed?

The DBS procedure is completed in four phases:

• Anchor placement – The first clinic visit will be to place 4 small anchor screws in the skull and complete a CT scan which will help our surgeons plan the trajectory of the electrodes. From this imaging, a 3-D printed stereotactic frame is customized to you to guide the electrode placement during the surgery.
• Electrode implantation – Roughly 2 weeks after your clinic visit, you will have surgery to place the electrodes. You will remain awake during surgery, and numbing medication will be given in the scalp to make you comfortable. Through small holes in the skull, electrodes will be inserted into your brain. The team records the process as the lead moves through your brain to ensure accurate placement. You may be asked to move your face, arm or leg at certain times while the recordings are being taken to evaluate the lead location and stimulation strength. Once the optimal location has been confirmed, the recording electrodes will be removed and replaced with the permanent electrodes. The entire procedure will last approximately 2-3 hours and you will recover in the hospital for 1-2 days. If your treatment plan requires insertion of leads on both sides of the brain, these are placed at separate surgeries about three weeks apart.
• Neurostimulator implantation – Approximately 1-2 weeks after your lead implantation surgery or surgeries, you will return to have the neurostimulator (pulse generator) implanted. Under general anesthesia, our surgical team will implant the neurostimulator under the skin, usually near your collarbone. The neurostimulator is connected to an extension wire leading to the electrodes. This is an outpatient surgery and you will be able to go home the same day.
• Neurostimulator programming – A few weeks after your neurostimulator implantation, you will return to the office to have the neurostimulator programmed for optimal electrical stimulation. Programming takes time, and may require several appointments for adjusting the settings. At this time, your doctor will address your medications and dosages so that your medications work effectively with the electrical stimulation to control your symptoms.

After your procedure, you will need to return periodically for checkups. Your doctor will determine the frequency of follow-up appointments depending on your particular situation.