Deep Brain Stimulation (DBS) for Tremors
Brain stimulator implant for the treatment of essential tremor
Essential Tremor Treatment
Beth Israel Deaconess Medical Center (BIDMC) specialists offer deep brain stimulation (DBS) to treat certain neurologic conditions, including tremors.
Essential tremor is a common movement disorder that usually affects the arms or hands. Living with tremors can be frustrating, embarrassing and even disabling at times. Daily activities such as dressing, feeding and writing become can become difficult to perform. Medications sometimes help, but not all people can control their tremors adequately with medications. Some turn to DBS as a way to further control tremors.
DBS uses a surgically implanted device called a neurostimulator, which is similar to a heart pacemaker. This device delivers electrical stimulation to the thalamus, a region of the brain. After surgery, our team monitors and adjusts the stimulator as needed during your follow-up visits to the clinic.
Candidates for DBS
There are many factors that help your doctor determine whether DBS could help you:
- Having essential tremor that medication cannot control well
- Being able to travel to BIDMC for regular follow-up visits for at least the first three months after surgery
- Being between the ages of 30 and 80 years
DBS is beneficial for treating action and resting tremors:
- Action tremor occurs while performing a task, such as bringing a cup of water to your mouth.
- Resting tremor is present when the arms and hands are resting or being still.
We most commonly perform DBS for essential or familial tremor. However, we can use it to treat other tremors. The surgery seems more helpful in controlling tremors affecting the arms rather than those affecting the legs. If you have bilateral (both sides) stimulation, you may notice improved head and voice tremor if you had these.
Getting Started
If you and your doctor decide you might be a good candidate for this surgery, you’ll meet with a number of specialists on our team and have a series of exams and tests. Through this process, we’ll be better able to tell if the surgery could help you without posing any unusual risk. This process will include these steps:
- Neuropsychological testing. You will meet with a neuropsychologist who will run tests to check how well your brain functions in these areas:
- Attention and concentration
- Executive functions
- Learning and memory
- Processing speed
- Reasoning
- Meeting with the neurosurgeon. You’ll also meet with the neurosurgeon who will perform the operation. During this thorough exam, you can ask questions or discuss any concerns about the surgery. If needed, our team also will schedule you for a brain MRI.
Once all these exams are complete, our team will review all of the results. We’ll work together to decide whether or not surgery is right for you.
If our team believes you should try further treatment with medication, we will provide these recommendations to you and your referring doctor. If we recommend DBS surgery, it’s usually scheduled about one month out. Once we schedule your surgery, you’ll get details about coming to the hospital for routine pre-operative tests.
More About DBS for Tremors
Some people notice a temporary improvement after the initial surgery — even before the pulse generators are in place. This improvement results from minor damage or swelling in nerve cells of the thalamus that occurs during the electrode-placement surgery. This sometimes causes a temporary reversal of symptoms lasting days or up to several weeks.
After a few weeks, you will return to the hospital. We will program your stimulator for optimal control of your particular symptoms. You will begin to notice an improvement almost immediately.
Tremor responds to stimulation very quickly — even within a few moments. If you turn the stimulation off at night before going to bed, the tremor will return shortly thereafter.
In a small number of people, the severity of tremor may continue to progress. In these cases, the initial improvement may decline over time.
Learn more about what to expect after DBS surgery.
Thalamotomy is another surgical option for people who have tremors that aren’t well controlled with medication. In this procedure, we use a heated electrode to identify and destroy the tissue in the brain that is causing the tremor. Thalamotomy is no longer a common procedure and can only be done safely on one side.
Focused ultrasound (FUS) is another surgical option for controlling tremor. The procedure involves focusing high energy ultrasound beams to thermally destroy targeted brain tissue.
This allows us to treat your tremor without creating holes in the skull and without needing to place a battery pack. Currently, FUS is a unilateral procedure, meaning it provides tremor relief on only one side of the body.
Thalamic DBS has some advantages when compared to these procedures:
- DBS does not destroy brain tissue.
- Stimulation is a reversible procedure.
- We can customize it to provide the best control for you.
- We can perform it on one or both sides of the brain. We typically perform one side first, followed by the other side several months later if necessary.
DBS has some disadvantages that are important to consider:
- Battery replacement — The battery must be replaced as needed. Battery life varies considerably and is highly dependent upon your device’s unique settings.
- Risk of complications — There is risk of complications such as infection at incision sites, electrode breakage and pulse generator failure.
- Return to clinic for frequent programming. Another disadvantage of DBS is the need to return to the outpatient clinic for re-programming. If you live a long distance from BIDMC or have problems arranging transportation, return visits to the hospital may pose a problem. In this case, DBS is probably not your best treatment choice.
Overall, we prefer thalamic DBS over thalamotomy because the procedure doesn’t destroy brain tissue. This lowers the risk of surgery-related neurological complications.
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