Deep Brain Stimulation
Our Approach to Deep Brain Stimulation
Deep brain stimulation (DBS) uses surgically implanted electrodes to deliver electrical impulses to your brain. It is an advanced treatment for several neurological and neuropsychiatric conditions.
Our specialists are world-renowned in image-guided functional neurosurgery procedures such as DBS. Our team approach includes the expertise of neurosurgeons, neurologists, advanced practice clinicians, neuropathologists, neuroradiologists, neuropsychologists, neuropsychiatrists, and nurses who bring you effective, leading-edge therapies.
Stanford Health Care was one of the first sites in the United States to perform DBS. We use the latest techniques, including ones developed by Stanford Medicine researchers, to increase your comfort and maximize your outcome.
What We Offer You With Deep Brain Stimulation Treatment
- Multispecialty team of neurologists, neurosurgeons, and advanced practice clinicians to advise each patient on the best treatment approach
- Groundbreaking research to advance new therapies such as medications, drug-free approaches, and electrical brain stimulation
- Nationally and internationally recognized specialists who have developed leading-edge techniques for performing DBS
- The latest treatments, including neuromodulation therapy, which uses implantable devices to reduce or prevent seizures before they start
What Is Deep Brain Stimulation?
About Deep Brain Stimulation
Deep brain stimulation is a surgery to implant electrodes into specific areas of your brain. These electrodes send out small electrical impulses that control irregular brain activity or chemical imbalances. A generator implanted beneath your chest controls the electrical impulses.
During DBS surgery, your neurosurgeon places three system components:
- Leads, which are thin, insulated wires with electrodes that the surgeon gently places into brain tissue through small openings in your skull
- Extension wires, which run through your head and neck to connect the electrodes and neurostimulator
- Neurostimulator, a small device similar to a pacemaker that the surgeon implants beneath the skin of your upper chest
Usually, your neurosurgeon implants electrodes on both sides of your brain to control symptoms in both sides of your body. Sometimes you may only need electrodes in one side of your brain.
Deep brain stimulation may be appropriate for some patients with neurological or psychiatric conditions. Doctors typically reserve the treatment for cases where medications don’t effectively control symptoms or the side effects interfere with your quality of life.
DBS doesn’t cure a neurological or psychiatric condition, and it may not fully resolve symptoms. For the right patients, however, it can reduce symptoms significantly and improve quality of life.
Stanford Medicine doctors have been using DBS for more than 25 years. Our experienced team has specialized training in programming the DBS system. We set up the deep brain stimulator with great precision and accuracy, continually evaluating and adjusting it as needed.
Our team of neurologists, neurosurgeons, and advanced practice providers uses minimally invasive, non-destructive, reversible therapies. We can help you understand all your options, from the latest medical therapies to surgical approaches such as DBS.
What to Expect During Deep Brain Stimulation
DBS treatment involves two surgical procedures to implant leads in your brain and the neurostimulator in your upper chest. Your surgeon places the leads by creating two small openings in the bone.
Before
During
After
Before the Procedure
During your initial evaluation, you see a team of specialists who determine if DBS is the right treatment for you. An important way to determine if DBS will help is to evaluate you both when you are taking medication and off medication.
You will receive medication instructions before your appointment. For example, if you have essential tremor, you may need to gradually stop using medication. If you have Parkinson’s disease, you may take extra medication one day and no medication the following morning.
The evaluation may include:
- A brain MRI and CT scan
- Comprehensive assessment by a neurologist
- Computerized balance testing
- Physical and emotional readiness assessment for surgery by a neuropsychologist
After your evaluation, the team meets to discuss your case and possible risk factors. If DBS surgery is right for you, you will have a follow-up visit with a neurosurgeon. During the visit, the neurosurgeon answers your questions and discusses surgical options and risks. After the discussion, you decide together whether to pursue surgery.
Additional appointments before your surgery include:
- A meeting with your anesthesia team and an anesthesiologist
- A presurgical medical history intake
- A physical exam
During the Procedure
DBS involves two separate surgeries to place the DBS leads and the generator.
Lead placement
We use the most advanced techniques to implant DBS leads. During surgical lead placement:
- Your neurosurgeon numbs your scalp. Depending on your procedure, you may receive a sedative to remain relaxed but awake during the operation, or you may be put to sleep.
- Your neurosurgeon makes a small incision about 2.5 centimeters long on one or both sides of your head. Then they create one or two dime-sized openings in your bone called burr holes. They insert the leads through the burr holes.
- Your surgeon uses advanced technology called microelectrode recording to “listen” to your brain cells as they insert the lead. This allows them to pinpoint exactly where the lead should go in your brain.
- Your neurologist will move your arms and legs and the team listens to the response from your brain cells. They test stimulation for any side effects. This helps your neurosurgeon ensure the leads are positioned correctly to maximize symptom control and minimize side effects.
- Your neurosurgeon places the back end of the leads behind your ear, underneath your scalp.
It takes about two to three hours to place leads in both sides of the brain. Your surgery may be shorter if your surgeon is only placing leads in one side of your brain. You’ll spend one night in the hospital after lead placement.
Neurostimulator placement
Typically this procedure will be several days to a few weeks after the first procedure.
During neurostimulator placement:
- You receive general anesthesia that puts you in a sleep-like state.
- Your surgeon makes an incision near your collarbone and places the generator in your upper chest.
- Your surgeon makes another incision behind your ear where they placed the back end of the lead. Then they implant extension wires that pass beneath the skin of your neck and scalp to connect the generator to the brain leads.
Neurostimulator placement is an outpatient procedure, meaning you can return home the same day. It usually takes about 30 minutes.
After the Procedure
You return to the neurology clinic about one month after surgery to begin your DBS programming visits. During the programming visit, your neurologist evaluates you and programs the neurostimulator. We monitor your movements to help determine the correct settings and intensity for the stimulator.
You see your team again regularly to help optimize your treatment. During these visits, we may gradually increase the settings on your neurostimulator. Eventually, we may reduce your medications.
Caring for your device
You will receive an identification card from the company that manufactures the deep brain stimulator to carry with you at all times. Present the card if you are in a situation that might affect the device.
Most electrical devices will not harm the DBS system. These systems are MRI compatible, though you should let your care team know that you have a DBS system beforehand.
Do not have any of the following procedures on skin or tissue directly over the stimulator:
- Electrocautery
- Electrolysis
- Radiation
- Ultrasound
Accidentally deactivating the stimulator will not harm you. However, any symptoms that the device controlled or eliminated will return. Your doctor will give you a hand-held device to turn the stimulator back on, if it is accidentally deactivated.
Before the Procedure
During your initial evaluation, you see a team of specialists who determine if DBS is the right treatment for you. An important way to determine if DBS will help is to evaluate you both when you are taking medication and off medication.
You will receive medication instructions before your appointment. For example, if you have essential tremor, you may need to gradually stop using medication. If you have Parkinson’s disease, you may take extra medication one day and no medication the following morning.
The evaluation may include:
- A brain MRI and CT scan
- Comprehensive assessment by a neurologist
- Computerized balance testing
- Physical and emotional readiness assessment for surgery by a neuropsychologist
After your evaluation, the team meets to discuss your case and possible risk factors. If DBS surgery is right for you, you will have a follow-up visit with a neurosurgeon. During the visit, the neurosurgeon answers your questions and discusses surgical options and risks. After the discussion, you decide together whether to pursue surgery.
Additional appointments before your surgery include:
- A meeting with your anesthesia team and an anesthesiologist
- A presurgical medical history intake
- A physical exam
close Before
During the Procedure
DBS involves two separate surgeries to place the DBS leads and the generator.
Lead placement
We use the most advanced techniques to implant DBS leads. During surgical lead placement:
- Your neurosurgeon numbs your scalp. Depending on your procedure, you may receive a sedative to remain relaxed but awake during the operation, or you may be put to sleep.
- Your neurosurgeon makes a small incision about 2.5 centimeters long on one or both sides of your head. Then they create one or two dime-sized openings in your bone called burr holes. They insert the leads through the burr holes.
- Your surgeon uses advanced technology called microelectrode recording to “listen” to your brain cells as they insert the lead. This allows them to pinpoint exactly where the lead should go in your brain.
- Your neurologist will move your arms and legs and the team listens to the response from your brain cells. They test stimulation for any side effects. This helps your neurosurgeon ensure the leads are positioned correctly to maximize symptom control and minimize side effects.
- Your neurosurgeon places the back end of the leads behind your ear, underneath your scalp.
It takes about two to three hours to place leads in both sides of the brain. Your surgery may be shorter if your surgeon is only placing leads in one side of your brain. You’ll spend one night in the hospital after lead placement.
Neurostimulator placement
Typically this procedure will be several days to a few weeks after the first procedure.
During neurostimulator placement:
- You receive general anesthesia that puts you in a sleep-like state.
- Your surgeon makes an incision near your collarbone and places the generator in your upper chest.
- Your surgeon makes another incision behind your ear where they placed the back end of the lead. Then they implant extension wires that pass beneath the skin of your neck and scalp to connect the generator to the brain leads.
Neurostimulator placement is an outpatient procedure, meaning you can return home the same day. It usually takes about 30 minutes.
close During
After the Procedure
You return to the neurology clinic about one month after surgery to begin your DBS programming visits. During the programming visit, your neurologist evaluates you and programs the neurostimulator. We monitor your movements to help determine the correct settings and intensity for the stimulator.
You see your team again regularly to help optimize your treatment. During these visits, we may gradually increase the settings on your neurostimulator. Eventually, we may reduce your medications.
Caring for your device
You will receive an identification card from the company that manufactures the deep brain stimulator to carry with you at all times. Present the card if you are in a situation that might affect the device.
Most electrical devices will not harm the DBS system. These systems are MRI compatible, though you should let your care team know that you have a DBS system beforehand.
Do not have any of the following procedures on skin or tissue directly over the stimulator:
- Electrocautery
- Electrolysis
- Radiation
- Ultrasound
Accidentally deactivating the stimulator will not harm you. However, any symptoms that the device controlled or eliminated will return. Your doctor will give you a hand-held device to turn the stimulator back on, if it is accidentally deactivated.
close After
Our Clinics
213 Quarry Road
213 Quarry RoadPalo Alto, CA 94304
Phone: 650-723-6469 Getting Here
To schedule an appointment, please call 650-723-6469
Deep Brain Stimulation
Deep brain stimulation uses electrical pulses to stimulate certain parts of the brain. It may treat Parkinson’s disease, epilepsy, or a movement disorder.
Deep brain stimulation
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what is deep brain stimulation
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