Deep Brain Stimulation
Most Advanced Care for Pediatric Movement Disorders
For some children whose movement disorders cannot be managed with medication or other therapies, Children’s Health℠ offers a promising technique called deep brain stimulation.
Deep brain stimulation (DBS) acts like a pacemaker for the brain by reordering nerve impulses that cause unwanted movements. Neurosurgeons implant a small neurostimulator under the skin in the chest with electrodes inserted into the brain. This sends impulses to the deep brain structures to control involuntary muscle movements.
A neurologist programs the implanted neurostimulator about a month after surgery. Adjustments will be made at future appointments as your child and doctor find the best settings for your child.
Deep brain stimulation is not a cure for movement disorders. When the signals are off, the movements will return. However, it has been found to reduce symptoms for certain conditions between 60 and 90 percent.
Who’s a Good Candidate for Deep Brain Stimulation Therapy?
According to FDA regulations, children who are 7 years or older are eligible to be considered for the device. Deep brain stimulation can be used to treat several pediatric movement disorder conditions including:
- Chorea – a movement disorder that causes uncontrolled wiggling or flowing movements
- Dystonia – a movement disorder that causes twisting, often painful muscle contractions and abnormal postures
- Myoclonus – a movement disorder that causes quick, involuntary muscle jerks
- Tremors – rhythmic shaking that can affect the arms, feet, hands, head or legs
The best candidates are children whose joints are not already stuck in one position from their movement disorder.
Physicians will prescribe other therapies or medications first before recommending deep brain stimulation as a treatment. Your child will meet with a team led by pediatric neurologist Dr. Jeff Waugh when discussing the surgery and deep brain stimulation. They also will undergo neuropsychological testing and magnetic resonance imaging (MRI) before surgery.
How Does Deep Brain Stimulation Surgery Work?
Surgery to implant the neurostimulator and electrodes lasts about half a day. Your child will be under general anesthesia and will spend the night at the hospital after surgery.
The devices implanted during surgery include:
- One or two leads (electrodes) inserted into the brain, tucked under the skin behind the right ear.
- Extension wires that connect the electrodes in the brain to the neurostimulator in the chest. These wires pass under the skin behind the right ear.
- A neurostimulator implanted beneath the skin in the chest below the collarbone.
Specifically, leads are inserted through a small opening in the skull using MRI imaging to guide precise placement in the brain. A patch of hair will be shaved on that part of the head. An incision will also be made behind the right ear to reach and guide the leads. The neurostimulator will then be placed in the chest with an incision made below the collarbone. In many cases, both the lead and neurostimulator placement occurs during the same surgery.
The patient will return to the neurologist about a month after surgery, giving the brain time to heal. The neurostimulator will be turned on and adjusted over time as the patient and doctor discover what settings are best for that patient.
The neurostimulator will need to be replaced every few years when the battery runs out. This is a minor outpatient surgery that only requires a small incision in the chest.