Deep Brain Stimulation Implantation (DBS)

What is Deep Brain Stimulation (DBS) Implantation Surgery

Deep brain stimulation implantation is a procedure to insert a wire (lead) into one side or both sides of the brain to deliver electrical currents to an area that is causing problems.

The lead is attached to a power source that is implanted under the skin near the collarbone, chest, or abdomen. This procedure may be done to treat various medical conditions, such as Parkinson disease, essential tremor, and other neurological conditions that cannot be controlled with medicines.

After the device is implanted, it can be used 24 hours per day. The intensity and frequency of the pulses are programmed for each individual and can be adjusted.

The DBS device has three parts:

• A lead. This is a thin wire. It goes through one or two small openings in your skull. It delivers the electrical pulse.
• A power source. This is called the neurotransmitter. It is usually placed under the skin in the upper part of your collarbone, chest, or abdomen, similar to how a heart pacemaker is inserted. It is powered by a long-lasting battery.
• An extension. This is a wire that connects the lead to the power source. The extension is passed under the skin of your head and neck and down to the power source.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or parts of the device.
• Damage to other structures or organs.
• Temporary tingling in the face, arms, or legs.
• Temporary pain or swelling in the areas where the wires are placed.
• Slight problems with vision or speech.
• Slight problems with balance.
• Slight loss of movement.
• Some jolting or shocking sensations.
• Trouble concentrating.
• Dizziness.
• Confusion.
• Mood changes.
• Trouble sleeping.
• Leaking of fluid from around the brain.
• Headaches.
• Stroke.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• Plan to have someone take you home after the procedure.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An area of your scalp will be shaved.
• An IV tube will be inserted into one of your veins.
• You may be given a medicine to help you relax (sedative).
• The surgery to insert a DBS device will be done in two parts:
  • Inserting the lead.
  • Inserting the neurotransmitter and extension wire.

1. Inserting the Lead

You will be awake during this part of the procedure.

• You will be given a medicine to numb the scalp area (local anesthetic). This will be injected into your scalp.
• Your head will be placed into a head frame to keep your head still.
• One or two small holes will be drilled through your skull.
• A thin tube will be threaded through each hole to place the lead.
• MRI will be used to make a map of your brain. This will show the part of the brain that needs to be treated.
• The surgeon will ask you various questions. This will help the surgeon to find the most appropriate part of the brain to place the leads.
• As soon as the lead is in the proper position, it will be attached to the extension wire.
• A plastic cap will be placed over each drill hole, and the scalp will be closed with stitches (sutures).

2. Inserting the Neurotransmitter and Extension Wire

This part of the procedure may be done at the same time or later. It may be done on one side or both sides of the head.

• You will be given a medicine to make you fall asleep (general anesthetic).
• A small incision will be made in the skin behind your ear. The extension wire will be inserted through this opening.
• A second incision will be made in the upper part of your collarbone, chest, or abdomen. This is for the neurotransmitter.
• The extension wires will be run under your skin from the area behind your ear to the incision in your upper collarbone, chest, or abdomen.
• In the area of your collarbone, chest, or abdomen, a pocket will be made under the skin to hold the stopwatch-size neurotransmitter.
• The incision will be closed with sutures or staples. A dressing will be applied.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• Do notdrive for 24 hours if you received a sedative.
• You will need to return for a follow-up visit to have your device programmed.

Care After Deep Brain Stimulation Implantation Surgery

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Soreness or pain near your scalp or your incisions.
• Swelling or bruising near your scalp or your incisions.

Follow these instructions at home:

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Bathing

• Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do notdrive for 24 hours if you received a sedative.
• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• Keep all follow-up visits as told by your health care provider. This is important.

Use Instructions for a Deep Brain Stimulation (DBS) Device

• Return to your health care provider to have your DBS device programmed and to be taught how to use it. Usually, the device is programmed about 2–4 weeks after surgery.
• Visit your health care provider as told for as long as you have your device. The device battery will need to be changed after several years.
• Tell all of your health care providers that you have this device. Remind them that you have the device before they do any tests or procedures, such as MRI.
• Have an ID card and a medical alert bracelet to let people know that you have an implanted medical device.

Contact a health care provider if:

• Your symptoms get worse.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from the incision area.
• You have a fever.
• You have confusion, mood changes, or trouble sleeping.
• You have dizziness.
• You have tingling, numbness, shocking sensations, or uncontrolled movements.
• Your device is no longer working.

Get help right away if:

• You have a sudden onset of any of these symptoms:
  • Headache.
  • Confusion.
  • Nausea and vomiting.
  • Vision changes.
  • One-sided facial drooping or arm weakness.
  • Loss of ability to speak, understand speech, or both.
• You have a seizure.