Having deep brain stimulation

During your surgery, a frame will be positioned around your head to help avoid movement during the procedure. Small holes are then drilled into the skull before 2 thin, insulated wires (each with electrodes known as ‘contacts’) are inserted into your brain.

Rarely, when the symptoms mainly affect 1 side of the body, these leads are only inserted on one side of your brain. The lead implanted in the left side of the brain controls symptoms affecting the right side of the body and the lead implanted in the right side of the brain controls symptoms on the left side of the body. 

Your surgeon will implant the leads into a specific area of the brain that’s best for you – the position won't be the same for everyone. After surgery, you might have a detailed scan of your brain (CT scan) to make sure the leads are in the correct place. 

Surgery is performed in a different way at each surgical centre. It will either take place under general anaesthetic (when you’re asleep) or you may be awake for part of the procedure. If you have a general anaesthetic and you’re asleep during surgery, you may be briefly woken up to check for improvements in your symptoms. 

When you speak to staff at the surgical centre, ask them how they carry out the operation. 

The procedure is either completed during 1 operation or during 2 separate operations. This might happen so that the device can be implanted a few days after the leads. 

There are other variations between surgical centres, including: 

• choosing the right target site in your brain for placing the leads
• whether or not your hair is shaved
• when the stimulator is switched on and programmed 

The team at your surgical centre can give you more information about how they do each of these things.

There are several DBS devices available that transmit the electrical current needed. These are called pulse generators or neurostimulators. There are rechargeable and non-rechargeable devices available.

Different manufacturers make different devices and the team at your surgical centre will explain which are available and the advantages of each one. 

Non-rechargeable pulse generator 

On average, the battery lasts between 3 and 5 years depending on the settings required. Some batteries for non-rechargeable devices may last longer than chargeable ones before a replacement is needed. 

Rechargeable pulse generator 

If you have a rechargeable unit implanted, you’ll be taught how to use it.

The pulse generator will need recharging regularly, and you’ll need to take your recharging unit with you if you’re going to be away from home for more than a few days. The battery will usually last between 15-25 years (depending on the manufacturer) before it has to be replaced.

There are precautions that need to be taken with each device, but these will vary depending on the manufacturer and model. The team at your surgical centre will be able to give you information specific to your device, so make sure you ask them any questions you have. 

The DBS system isn't switched on immediately. 

The system is switched on a few days or weeks after your surgery (depending on your centre). This allows an electric current to pass into your brain in order to improve your movement symptoms. 

Your specialist, such as your neurologist or DBS nurse, will programme the generator using a small portable computer. They’ll try out various settings to work out which ones are best for you, and which ones cause side effects.

Then over a few weeks, the settings will slowly be increased. At the same time, your medication may be adjusted as needed. 

Some people find that their symptoms actually get worse before they get better during these weeks. If this happens, you may experience issues such as increased dyskinesia and ‘off’ time until your stimulator settings and medication doses are right for you. 

You may also be given the option to make some changes to the settings. It may take up to 12 months to fully programme the stimulator and adjust your Parkinson’s medication to get the most benefit from your treatment. 

You may experience side effects from the stimulation that targets a specific area of your brain. These side effects can usually be managed by changing the programming of your DBS device. They include: 

• numbness or a tingling sensation 
• changes in speech or language, such as a soft voice, or problems speaking fluently or finding words
• dizziness or light-headedness 
• involuntary muscle contractions (dystonia or dyskinesia) 
• muscle tightness of the face or arm
• weakness of face or limbs
• problems with balance and falls 
• movement problems or reduced coordination 
• closure of the eyelids (although this is rare) 
• jolting or shocking sensations 
• temporary worsening of symptoms

These side effects can be uncomfortable but aren’t dangerous. Usually they can be managed by changing the settings on your device. 

You’ll usually need to stay in hospital for a short while after you’ve had surgery.

Before being discharged, healthcare staff should assess what support you may need once you go home. These will be recorded in a care plan. You shouldn't be discharged until the support you need has been put in place. 

Find out more aboutgoing into hospital when you have Parkinson’s. 

• If you go into hospital in the future, it’s important to make staff aware that you’ve had DBS surgery. You should also tell any other health professionals you see that you have a DBS system implanted. This includes dentists, surgeons and physiotherapists. 
• Diathermy (the use of a high-frequency electronic current to produce heat, often used for muscle relaxation) should not be used if you’ve had DBS surgery.
• If you need any surgery in the future, the surgeon and anaesthetist should be told you have a deep brain stimulator. There are certain precautions they'll need to take during surgery. 
• MRI scans can only be used under very strict conditions. 

Antibiotics have to be prescribed when there’s a risk of germs getting into your bloodstream. For example, during dental procedures or other surgery. Your specialist or Parkinson’s nurse can advise health professionals on this before antibiotics are prescribed. 

Most everyday activities are safe, but there are some that could damage the system. You should talk to your specialist about these. 

You can travel by plane, but you should inform airport security and carry a card with you that explains you’ve had DBS. Ask your health professional if they can provide one for you. You should also carry the handheld programmer with you when travelling, in case the stimulator is accidentally switched off.