Deep Brain Stimulation (DBS) for Dystonia
What is deep brain stimulation (DBS)?
Deep brain stimulation (DBS) is a surgical treatment for dystonia, a movement disorder characterized by nonstop or occasional muscle contractions that cannot be controlled. A battery-powered stimulator is implanted in the chest or abdomen and connected to thin leads in the brain to deliver electrical pulses that reduce dystonia symptoms.
Who is a candidate for DBS?
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 severe cases, it is considered as an option for patients with acquired dystonia, such as cerebral palsy.
Deep brain stimulation is more effective when started early in life, within a few years of the start of symptoms.
How is deep brain stimulation performed?
Deep brain stimulation surgery is done while your child is under general anesthesia.
Two small incisions are made in the scalp and an opening made in the skull just large enough to insert two DBS leads. These leads are the thickness of a strand of spaghetti and have electrodes at their ends. Using a combination of magnetic resonance imaging (MRI) and real-time electrical recordings of the cells in the brain, the neurosurgeon places the leads so that the electrodes are precisely located where they will be most effective in controlling movement symptoms.
The battery-powered stimulator is then surgically implanted just below the skin in the chest or upper abdomen. Wires connect the stimulator to the leads.
What to expect during deep brain stimulation
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. These tests are primarily physical neurological examinations by our expert neurologists as well as MRI of the brain.
The procedure is planned to position the wire ends at those precise points, and to place the stimulator device where it will be least noticeable under the skin on your child’s chest or abdomen.
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 several hours.
Your child will stay in the hospital for one to two days for recovery.
Activating and adjusting the stimulator
The stimulator is not turned on when first implanted. Your child’s doctor will activate it as an outpatient, a couple weeks after surgery.
Relief from symptoms is not immediate with activation. Expect gradual improvement over a period of several months. Most children will eventually experience a substantial reduction in symptoms.
Follow-up care after DBS surgery
Your child’s doctor will need to adjust the settings on the device in follow-up appointments in the weeks and months after the device is activated 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 DBS will continue to take medicine for dystonia, and the dosage will be adjusted over time to achieve the best effect and reduction of symptoms.
The stimulator battery will need to be replaced every several years.
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.
Your child will have access to a broad team of specialists with expertise in every element of the care of children with dystonia, and are committed to staying abreast of the latest technology available and innovative approaches to treatment.
Our Divisions of Neurosurgery and Neurology are leaders in the field of pediatric deep brain stimulation, and maintain a multi-institutional database of pediatric deep brain stimulation patients to further our understanding of dystonia and its treatment through collaborative research.