Deep Brain Stimulation (DBS)

I have a particular interest and extensive experience in deep brain stimulation (DBS), and I am the director of the DBS surgical program Swedish Medical Center.

If you live near Denver and have a condition that might be treated with DBS (essential tremor, Parkinson’s disease, dystonia, or epilepsy), please consider meeting me in consultation to learn more about the procedure. You can also find my DBS guide for patients here.

Below is information about DBS and my surgical practice.

rapid-fire answers to COMMON questions about how I perform DBS:

• How often do you do DBS?

  • I do over 150 movement disorder surgeries per year and an additional 50 epilepsy surgeries per year.

• Awake or asleep?

  • I perform DBS with the patient asleep (general anesthesia).

• What technique/platform do you use?

  • Robot-assisted lead placement (Rosa) with intra-operative CT.

• Which implant/device vendor?

  • I use all three (Medtronic, Boston Scientific, and Abbott), and I let you and your neurologist choose. I provide guidance, as needed.

• What is your infection rate?

  • Less than 0.5%.

Overview of DBS

Deep brain stimulation (DBS) is a safe, effective, and well-established therapy for treating neurologic disorders like Parkinson’s disease, essential tremor, epilepsy (seizures), and dystonia, among others. DBS is sometimes referred to as a “pacemaker for the brain.” One or two thin wires are inserted into the brain and then connected to a small battery that is implanted under the collarbone.

DBS delivers electrical pulses precisely to a tiny spot in the brain. You will not be able to feel these pulses, but the benefits are often immediate and profound.

Neurosurgeons have been using DBS in the United States for over 25 years. Clinical trials have demonstrated a variety of benefits for patients, including improvements in movement in Parkinson’s disease and essential tremor, and dystonia, and a reduction in seizures in epilepsy. A consistent benefit for all of these disorders is that patients who receive DBS therapy report a better quality of life.

The DBS system sits entirely beneath the skin, and it is not visible from the outside in most patients during daily life. Below is a CT scan of the brain implant as well as a photograph of the two main system components: the brain wire and the battery.

Determining Eligibility for DBS

The evaluation for DBS therapy begins with a discussion between myself and your neurologist regarding whether DBS is right for you. Most patients need additional testing, such as an evaluation with a neuropsychologist. At your appointment with me, I will review your medical history, symptoms, and test results, perform a physical examination, and discuss whether and how DBS might be helpful for you.

Surgery and recovery

If you decide to proceed with DBS, I will order an MRI and CT scan of your brain to plan the surgery. Implanting DBS consists of two procedures. In the first procedure, I implant one or two tiny wires (just over 1 millimeter) into the brain. I use an advanced surgical robot to help improve accuracy. I perform DBS with you asleep (general anesthesia). Most patients stay one night in the hospital and go home the following morning. In the second procedure, I implant a small battery just under the collarbone. This is usually 1-3 weeks after the first procedure. Implanting the battery is a day/outpatient surgery (no overnight stay).

Most patients can resume normal activity fairly quickly after surgery. I advise avoiding strenuous exercise and heavy lifting for 2-4 weeks; otherwise, you can continue with most of your normal daily activities. After you have healed from surgery, your neurologist will turn on the stimulator. Most patients need 2-3 neurology appointments, usually spaced out a few weeks at a time, to get the settings just right.

If you or a family member has Parkinson’s disease, essential tremor, epilepsy, or dystonia, please click on the corresponding link to learn more about how DBS therapy can help You can also find information about scheduling a consultation in my office here.

If you are a patient of mine who is considering or planning for DBS surgery, you can access my DBS patient instructions. This document outlines how to prepare as well as what to expect before and after surgery.