What is deep brain stimulation (DBS)?

Deep brain stimulation (DBS) is a surgical treatment in which an implanted device delivers electronic stimulation to targets deep in the brain.

A small battery-powered stimulator is implanted in the chest with two wires leading to points within the brain. The wire ends emit electrical stimulation that can reduce seizures or symptoms of movement disorders like dystonia.

Who is a candidate for deep brain stimulation (DBS)?

Children with dystonia

DBS is considered as a treatment for patients with inherited dystonia or dystonia with no known cause whose symptoms are severe and who are not adequately helped by medication. In some cases, it is considered as an option for patients with acquired dystonia, such as cerebral palsy.

Deep brain stimulation for dystonia is more effective when started early in life.

At Children’s Hospital of Philadelphia (CHOP), your child will have access to a broad team of specialists who have expertise in every element of the care of children with dystonia and are committed to exploring the latest technology available and innovative approaches to treatment.

Children with epilepsy

Deep brain stimulation is considered as a treatment for patients with epilepsy who have focal, multifocal, generalized, or a mix of seizure types that are not controlled by medications, after at least two medications have been tried.

In some cases, seizures may originate in areas of the brain that control critical functions, or in many different areas. In these cases, deep brain stimulation for epilepsy can be an alternative to traditional surgical procedures that remove brain tissue, reducing the risk of neurologic deficits. At CHOP, your child will have access to pediatric experts from the Pediatric Epilepsy Program, as well as the Division of Neurosurgery and others who specialize in the care of children with epilepsy and seizures.

How is deep brain stimulation performed?

Deep brain stimulation surgery is done while your child is under general anesthesia.

Two small incisions on the scalp and an opening in the skull are made just large enough to insert two DBS electrodes. These electrodes are the thickness of a strand of spaghetti. Using a combination of magnetic resonance imaging (MRI) and real-time electrical recordings of the cells in the brain, the neurosurgeon places the electrodes precisely where they will be most effective in controlling movement symptoms or seizures.

The battery-powered stimulator is implanted through a small incision in the chest and connected to wires just under the skin. These wires connect the stimulator to the electrodes.

What to expect during deep brain stimulation

Before deep brain stimulation surgery

Before your child undergoes DBS surgery, tests will be done to determine whether your child is likely to benefit from DBS and to identify the points in your child’s brain where the implanted electrodes will be most effective. An advanced type of MRI is required before deep brain stimulation to assist the surgical team in visualizing the electrode targets. Our expert neurologists will also conduct various physical neurological examinations.

These tests allow the surgical team to determine the precise points to be targeted in the procedure. The procedure is planned to position the wire ends at these precise points, and to place the stimulator device where it will be least noticeable under the skin on your child’s chest.

On the day of the surgery and immediately after

On the day of the surgery, your child will undergo general anesthesia. At Children’s Hospital of Philadelphia (CHOP), you can trust our specially trained pediatric anesthesiologists to keep your child comfortable and safe before, during and after their procedure. Read more about our dedicated pediatric anesthesiology team.

The surgery itself takes four to five hours.

Your child will stay in the hospital overnight for recovery and will be released 1-3 days later. No extended bed rest is required, and your child will be able to return to normal activities within a few days.

Follow-up care after DBS surgery

Your child will return for a follow-up appointment with our DBS team a few weeks following surgery to have the stimulator turned on.  Follow-up visits in the weeks and months after the device is activated will allow your child’s provider to adjust the stimulator’s settings in order to find the optimal charge level and pulse timing.

Regular follow-up visits will be needed after that to continue to adjust the stimulator setting and to monitor battery level. Most children with dystonia who undergo DBS will continue to take medicine for dystonia, but the dosage will be adjusted over time to achieve the best effect and reduction of symptoms.

Long-term effects of deep brain stimulation

Deep brain stimulation doesn’t end all seizure activity, but it reduces the number and severity of seizures experienced. By optimizing the settings of the stimulator, seizure frequency can be reduced further over time.

In general, studies have found that:

• Most patients who undergo DBS have fewer seizures
• DBS therapy can reduce seizure severity
• It can take months to a year or more to see the full benefits of DBS
• Many patients continue to have improvement of their seizures many years after DBS surgery
• In most cases, medications will still be needed after DBS treatment. If seizure control improves with DBS, seizure medications may be lowered to lessen side effects.

Deep brain stimulation post-operative care

For the most part, everyday activities shouldn't interfere with or damage your DBS system. Some common activities for your child to avoid include:

• Activities that include sudden, excessive or repetitive bending, twisting or stretching
• Walking through metal detectors like those at airports and department stores
• Putting a heating pad on the DBS system

Take the following actions:

• Always carry the DBS Device Identification Card sent to you by Medtronic, the manufacturer of your child’s DBS device
• Tell all your child’s medical providers they have an implanted DBS system and tell them where it is located
• Check with the child’s doctors before they have an MRI or any other medical procedure
• Protect the neurostimulator area from trauma during sporting activities

Why choose CHOP for deep brain stimulation

At Children’s Hospital of Philadelphia, our Division of Neurosurgery works closely with the Division of Neurology and Center for Rehabilitation to ensure that patients are screened appropriately for a deep brain stimulation implant, and to provide the full range of supportive therapy before and after surgery in order to optimize outcomes.

CHOP's Neuroscience Center brings together world-renowned specialists in pediatric Neurology and Neurosurgery who have extensive experience in the field of pediatric deep brain stimulation. We maintain a database of pediatric deep brain stimulation patients to further our understanding of dystonia and epilepsy, and their treatment through collaborative research.