Getting deep brain stimulation (DBS) for essential tremor

What to expect from DBS surgery

From the evaluation stage through living with your device, you’ll have the support of a neurologist and neurosurgeon with special training and experience with DBS therapy.

Step 1: Evaluation

Determine whether or not you are candidate 

Your neurologist — typically a movement disorder specialist  — will evaluate you to see if DBS is a good option for you. The evaluation usually includes:

• Medical history

• Neurological exam of your movements, both on and off medications

• MRI of the brain to check whether there are any issues that would pose a risk during the surgery

• Lab tests, such as a blood test to make sure your blood clots properly

• Neuropsychological tests

Your neurologist will share the results with you, and together you will decide whether or not to go forward with the therapy.

Step 2: Planning 

Preparing for your journey 

Your neurosurgeon will create images and maps of your brain to help guide the placement of the lead during the surgery. You will have an MRI and CT scan to capture images of your brain.

Step 3: Surgery 

Placing the system

There are two parts to the DBS surgery: placing a thin wire (lead) in the brain and implanting the neurostimulator (a pacemaker-like device), under the skin of the chest. These procedures may be done on the same day or on different days.

For placement of the lead, you may be either awake or asleep (under deep sedation or general anesthesia) depending on your neurosurgeon’s recommendation. Differing from other DBS systems, Medtronic has FDA approval for both awake and asleep DBS to give your neurosurgeon more surgical flexibility.

After checking that the lead is properly positioned, your neurosurgeon will place the neurostimulator under the skin of your chest, just below the collarbone. Your neurosurgeon will connect the lead to the neurostimulator using an extension that runs under the skin from the chest to your neck and head. You will be under general anesthesia for this part of the procedure.

Step 4: Programming 

Getting the initial settings right

A few weeks later, your neurologist will turn on the neurostimulator and adjust the stimulation to best control your symptoms while minimizing side effects.

• Most people don't feel the stimulation at all when it’s first turned on, but some feel a brief tingling.

• It will take a few programming sessions to find the stimulation levels that work best for you — don't get discouraged.

• You'll have follow-up visits to check your results and adjust as needed. These appointments are key to getting the results you want over time.

Step 6: Checkups 

Getting ongoing care 

It's extremely important to attend all your checkups with the neurologist who manages your DBS therapy. Your neurologist will:

• Make sure that your DBS system is working properly

• Adjust your stimulation to best control your symptoms

• Check the battery of your neurostimulator to see when you may need a device replacement