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Deep Brain Stimulation (DBS) is an advanced form of brain surgery that was developed to treat Parkinson's disease. It has been used for those with dystonia, a disorder characterized by involuntary muscle contractions that force certain parts of the body into abnormal, sometimes painful, movements or postures. DBS has also helps those suffering from essential tremors, tremors associated with multiple sclerosis and those suffering from severe depression.

The Movement Disorders and Parkinson's Program at UCSF Medical Center is the largest center for the surgical treatment of Parkinson's Disease in Northern California. Dr. Phillip Starr, co-director of the Functional Neurosurgery programs at UCSF, is a pioneer in DBS for the treatment of dystonia. Starr, along with surgeon Dr. Paul Larson, are investigators for the largest clinical trial of Parkinson's treatment through DBS currently taking place in North America.

Functioning like a "pacemaker" for the brain, DBS uses electrodes implanted in the brain to send out electrical impulses to different areas in the brain linked to disorders. The surgery and electrical impulse treatment do not destroy brain tissue.

When treating Parkinson's disease, for example, the inserted DBS device called a neurostimulator, sends electrical impulses through the wire into the brain to control the movement center. The stimulation blocks abnormal activity in the brain and relieves patients of tremors, rigidity, slowness of movement, stiffness and may help with other problems associated with their conditions. It does not, however, cure patients of their disorders.

The electrode stimulation can be adjusted as the patient's condition changes.

Procedure

DBS surgery involves putting the tip of a hair-thin wire inside the brain in a special area that controls movement. The patient is awake during surgery to allow the surgical team to assess the patient's brain functions. The small wire runs up through a small hole in the skull and under the scalp, down to a small device implanted under the collarbone. Local anesthetic is applied to these areas, and the patient is occasionally sedated.

While the electrode is being advanced through the brain, the patient does not feel any pain. Most dystonia patients have two implants — one on each side of the brain.

At UCSF, the two implants for dystonia patients are usually placed the same day. For adults, the surgery is done with the patient awake for part of the procedure, but children can have it done entirely under general anesthesia.

The most serious potential risk associated with the procedure is bleeding in the brain, which can lead to stroke. Risk of stroke ranges from 1 percent to 3 percent among patients. Infection, which occurs in 3 percent to 4 percent of patients, is another risk. If infection occurs, it is usually not life threatening, but may require removal of the entire DBS system.

Conditions

The following conditions are treated with Deep Brain Stimulation:

• Parkinson's disease
• Dystonia
• Essential tremor
• Other movement disorders

More Information

Dr. Phillip Starr is the co-director of the Functional Neurosurgery programs at UCSF. For more information or to refer a patient, please contact the program at (415) 353-7500.

Other doctors in the Functional Neurosurgery programs include co-director Dr. Nicholas M. Barbaro, Dr. Paul Larson and Dr. Nalin Gupta, director of the department's pediatric neurological Surgery Program.

For help finding a doctor, please contact the Physician Referral Service: