About Deep Brain Stimulation (DBS)

Our deep brain stimulation (DBS) program is one of the country’s most active, performing over 100 procedures each year. Conditions we treat with DBS include the following: Parkinson’s disease, essential tremor, dystonia (abnormal muscle contractions), obsessive compulsive disorder (OCD), Tourette’s syndrome, and severe depression. DBS has also been used experimentally to treat other neurological disorders such as Huntington’s disease and cluster headache.

What is Deep Brain Stimulation?

In deep brain stimulation (DBS), tiny electrodes are surgically placed in the brain. These are then connected to a pacemaker-like device called a pulse generator, that is implanted under the skin beneath the collarbone. This device produces a mild, continuous electrical stimulation that blocks the abnormal brain signals associated with disorders like Parkinson’s disease, essential tremor and dystonia. While DBS doesn’t cure these conditions, it can reduce many of their most disabling symptoms, significantly improving quality of life. DBS has been performed in the U.S. since the mid-1990s, and many patients are continuing to benefit over 15 years after their initial treatment.

How DBS Works

The effects of deep brain stimulation are much the same as creating a lesion in the brain tissue; however, they can be reversed by simply turning off the pulse generator. Stimulation is also adjustable. Each electrode has four contacts allowing fine tuning of the exact location of stimulation. Additionally, several stimulation parameters can be adjusted by the treating physician to optimize symptom control and minimize any side effects.

Deep brain stimulation treatment starts with a consultation to discuss the overall process. The patient is then evaluated by a neurologist specializing in movement disorders. If he or she is found to be a good candidate for DBS, another appointment is made with the neurosurgeon for further evaluation and to discuss the proposed procedure more fully.

DBS

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DBS Surgery

Our DBS surgeries are performed at NYU Langone’s Tisch Hospital, with outpatient follow-up available both in Manhattan and at our offices in Great Neck, Long Island. Surgery occurs in two stages: Stage 1, in which the electrodes are implanted in the brain, requires a one- or two-day hospital stay. Stage 2, in which the pulse generator (pacemaker) is implanted, is a same-day procedure.

Stage 1. Prior to the first surgery, a high-resolution MRI scan of the patient’s brain is done. At the time of the Stage 1 procedure, a CT scan of the brain is performed. The CT and MRI scans are then merged on a computer to guide the placement of the electrodes.

Next, under local anesthesia, a nickel-sized hole is made in the patient’s skull and the electrodes are placed into the brain. Light sedation is used, leaving the patient awake enough to perform certain tasks that help assure the response to the stimulation is beneficial and well tolerated. This procedure typically lasts four hours.

Stage 2. A week later, the patient returns to have the pulse generator (pacemaker) implanted and connected to the electrodes via wires under the skin. This surgery, performed under general anesthesia, typically takes two hours. The patient can usually go home on the same day as the procedure.

Activating the Pulse Generator

The pulse generator is activated about a week after the Stage 2 procedure, once the surgical wounds have healed. Our DBS team then works closely with the patient over several sessions to find the combination of settings that best control their symptoms. Following this adjustment period, most patients require only occasional maintenance visits.

Consultations for deep brain stimulation (DBS) may be scheduled by contacting the office of one of our doctors listed below. No specific testing is required prior to the initial consultation. At this consultation, a history of the patient's disease will be obtained, a neurological exam will be performed, and the general process of deep brain stimulation will be discussed. If it is felt that the patient may be a candidate for DBS, further neurological and neuropsychiatric evaluation will be set up.

Insurance Coverage for DBS

Most insurance companies now cover DBS for Parkinson’s, essential tremor, dystonia and OCD. Coverage for emerging indications that lack FDA approval may vary. The Center for Neuromodulation will work closely with you and your insurer to help facilitate coverage.

Meet Our Doctors: