Implantation of lead

1. Numbing medicine will be injected into your scalp. A head frame will be placed to keep your head in the right position for the procedure. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan will be taken to find the target site in the brain for the electrode.

2. You will be awake during the surgery. You will be asked to move certain parts of your body as the lead is being placed.

3. After more numbing medicine is injected into your scalp, the neurosurgeon will drill a small hole in the skull to insert the lead.

4. Recordings will be taken as the lead is moved through the brain tissue. This helps pinpoint the exact place for the lead. You may be asked to move your face, arm, or leg at certain times while the recordings are being taken.

5. Once the precise location for the lead has been found, it will be attached to an external neurostimulator. Electrical stimulation will be given through the lead for a short time to see if symptoms improve. Your surgeon may cause side effects on purpose with electrical stimulation to make sure the lead is in the right place. 

6. The lead will be attached after it's in the right place. A wire to connect the lead to an extension to the neurostimulator will be placed under the scalp.

7. The hole in the skull will be closed with a plastic cap and stitches.

Placement of the neurostimulator

This may or may not be done at the same time the electrode is placed.

1. You will receive general anesthesia so that you are asleep during the procedure.

2. The neurostimulator will be inserted into a “pocket” under the outer layers of skin tissue. This is often just under the collarbone, or in the chest or abdomen.

3. An extension wire will be attached to the neurostimulator and to the brain lead.

4. After the neurostimulator is implanted, it's programmed to send an electrical signal. Programming is often done a few weeks after the neurostimulator is put in.

Programming the neurostimulator

Programming the neurostimulator is a process that occurs over time. You will likely go back several times for adjustments to the settings. Your medicines may also be adjusted. The goal is to control your symptoms with the most appropriate amount of electrical stimulation and medicine.

Once your “best” settings have been determined, you will need to go back from time to time for checkups. Your healthcare provider will plan your follow-up schedule based on your particular situation.

The neurostimulator is about the size of a stopwatch. It's powered by a long-lasting battery that generally lasts 3 to 5 years. When the battery starts to wear out, the neurostimulator will be replaced with a new one in an outpatient procedure.

In the hospital

You will be watched for complications, such as seizures. In general, the hospital stay after a DBS procedure is 24 hours. But you may stay longer if problems develop. Before you are discharged from the hospital, arrangements will be made for a follow-up visit with your healthcare provider. They will also give you instructions for home care.

At home

Once you are home, it’s important to keep the incisions clean and dry. Your healthcare provider will give you specific bathing instructions. If stitches were used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry. They generally will fall off within a few days.

Living with a DBS neurostimulator

Consider these precautions. Talk about them with your healthcare provider:

• Always carry an ID card that states you have a DBS neurostimulator. You may also want to wear a medical ID bracelet.

• Let airport security screeners know you have a neurostimulator before going through the airport detectors. In general, airport detectors are safe. But the small amount of metal in the neurostimulator may set off the alarm. If you are chosen for more screening by handheld detector devices, politely tell the screener that the detector wand should not be held over your neurostimulator for longer than a few seconds. These devices contain magnets. They may affect the function or programming of your neurostimulator. You may want to bring a note from your healthcare provider about your implanted device.

• You may not have certain MRI procedures. That's because these machines use large magnets for imaging.

• You should stay away from places with large magnetic fields, such as power generators and automobile junkyards that use large magnets.

• Don't use heat in physical therapy to treat muscles.

• Stay away from high-voltage or radar machinery, such as radio or TV transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces.

• If you are scheduled for surgery, tell your surgeon that you have a neurostimulator long before the operation. Also ask your healthcare provider’s advice on whether anything special should be done before and during the surgery. The electrocautery device that controls bleeding may interfere with the neurostimulator.

• When doing physical, recreational, or sporting activities, protect yourself from harming the neurostimulator. A blow to the chest near the neurostimulator can affect how it works. If you are hit in that area, you should contact your healthcare provider right away to have it checked.

Long-term effects of DBS

DBS can help improve symptoms of tremors, stiffness, slowness, and movement problems. It can also help with medicine therapy by decreasing the dose needed. Decreasing the dose of medicine can ease side effects of long-term medicine use. Many people see their symptoms improve for several years after the procedure. They are able to do basic activities, such as eating, toileting, and dressing. Memory, thinking, and mood may or may not be affected. Many neurological conditions are progressive. So later problems can develop. If they do, the gains gotten from DBS may eventually be lost.