Deep brain stimulation

Deep brain stimulation (DBS) is a treatment involving surgery to insert a small device which stimulates a specific part of your brain.

It is sometimes offered to adults with uncontrolled seizures, who are unable to have other types of epilepsy surgery.

A radiologist showing a brain scan to their patient

Is DBS a good treatment for epilepsy?

The latest NICE guidelines say there is some evidence that one type of DBS can be useful for people with epilepsy. There are other types but NICE says there isn’t enough evidence that these work.

Who can have DBS?

It may be offered to you if your seizures have not been controlled by epilepsy medicine and if you’re not suitable for other types of epilepsy surgery. It is only offered to adults. There is no research into its use in children.

The decision about whether you will be suitable for surgery should be made by a team of epilepsy specialists. They should then discuss with you the possible benefits and risks before you decide if you want to agree to the surgery.

What does DBS surgery involve?

Deep brain stimulation involves implanting electrodes into specific areas of the brain where epileptic activity happens. An electrode is a small device through which an electrical charge can be sent or picked up.

The procedure is done using general or local anaesthetic. During a general anaesthetic, medicines are used to send you to sleep. During a local anaesthetic you will stay awake and medicines will be used to numb an area of your body. The procedure will involve the following steps:

  • A frame may be used on your head so that the electrodes go to exactly the right areas
  • One or more small holes are drilled in the skull and electrodes are implanted into the chosen areas
  • A neurostimulator is surgically placed beneath the skin below the collarbone. It is a small device about the size of a matchbox
  • The electrodes are connected to the neurostimulator by leads that are positioned under the skin of the neck and scalp
  • A handheld remote-control programming unit is used to turn the neurostimulator on or off, adjust its strength and frequency and monitor its activity

Is DBS safe?

The research on DBS for people with epilepsy is limited. But, the most common issues highlighted have been:

  • Pins and needles in the hands or feet
  • Pain where the implant is
  • Infection related to the device

More people with movement disorders such as Parkinson’s disease have had DBS surgery. Safety issues highlighted by research on people with movement disorders lists possible safety issues as:

  • Some bleeding or infection linked to the surgery
  • Neurological symptoms related to the stimulation
  • Infection and other issues related to the device

Overall, DBS has low rates of short and long-term complications.

How does DBS work?

When the DBS system is in place, small electrical impulses go from the neurostimulator into your brain, through the electrodes. These stimulate the part of your brain where there is epileptic activity, to stop your seizures happening.

About a month after the operation the surgeon will use a programming unit to turn the neurostimulator on, adjust the stimulation, and monitor activity. You will be given a hand-held programmer or a magnet, so that you can switch the stimulator on and off.

There is evidence that stimulation of one part of the brain can help people with uncontrolled seizures. Research shows that this type of DBS helps by reducing seizures in these patients. How well it works varies from person to person.

You may be more likely to respond well to DBS if:

NICE is clear that more research is needed to show how effective DBS is for people with epilepsy.

Published: December 2020
Last modified: July 2023
To be reviewed: December 2023
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