These pages are about treatment available in the UK. If you are looking for information in another country, please contact your local epilepsy organisation.
Deep brain stimulation (DBS) is a treatment where a part of your brain is stimulated, to stop you having symptoms of a particular medical condition. It’s called an interventional procedure. An ‘interventional procedure’ includes tests, treatments or surgery which involve making a cut to the skin. Surgery is needed to fit the DBS system.
There have been several studies where people with difficult-to-control epilepsy have had fewer seizures after having DBS surgery. The National Institute for Health and Care Excellence NICE has looked at these studies. In 2012 they issued guidance to UK healthcare professionals about making DBS available to certain people with epilepsy. This is still the most up-to-date guidance on DBS from NICE. The guidance is called Interventional Procedure Guidance 416 and this is a summary of what it says:
- DBS will only be considered for people who can’t have their seizures controlled by epilepsy medicines or other types of surgery
- There’s not much good evidence about how well DBS works
- After two years, more than half the people who had DBS had fewer seizures than before the surgery
- If you are being considered for DBS, a team of specialist doctors will work together, to make sure you and your epilepsy are suitable for the surgery
- If you are offered DBS, you should be told that the benefits are uncertain, and the surgery has risks
- Your doctor should discuss the risks with you, and give you written information before you decide whether to go ahead with DBS surgery
- Risks include bleeding in the brain, infection, depression and memory problems
In the UK, your hospital trust will need special funding before they can do DBS surgery.
In England, NHS England do not fund DBS treatment and access may be limited to people who are part of a clinical trial.
NICE has also written information about DBS for patients, which gives more detail.
What surgery for DBS involves
The surgery involves having a DBS system fitted. The DBS system has three parts.
• A lead – this is a thin, insulated wire. It is put through a small opening in your skull, to reach the part of your brain where the epileptic activity happens. Electrical activity is happening in our brain all the time. A seizure happens when there is a sudden burst of intense electrical activity. This is often referred to as epileptic activity.
• An extension – this is an insulated wire that is passed under the skin of your head, neck, and shoulder. It connects the lead to the neurostimulator.
• A neurostimulator – this is a small device, similar to a heart pacemaker. It is usually placed under the skin near your collarbone, lower in your chest, or under the skin of your stomach.
Before the surgery, a brain surgeon will give you a magnetic resonance imaging (MRI) or computed tomography (CT) scan. This is to see the exact part of your brain where the epileptic activity happens.
At the start of the surgery, you will take some drugs to make you relaxed and sleepy, but you might stay awake. You might have a frame attached to your face. The frame will be taken away when the surgery is finished.
After the surgery, the surgeon may give you another CT or MRI scan, to make sure the DBS is in the right place.
What DBS does
Once the DBS is in place, electrical impulses go from the neurostimulator, along the extension wire and lead, and into your brain. These stimulate the part of your brain where there is epileptic activity, to stop your seizures happening. 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.
If you think you or your child could be suitable for DBS, talk to your epilepsy nurse or specialist.
If you would like to see this information with references, visit the Advice and Information references section of our website. See Deep brain stimulation and epilepsy.
This information has been produced under the terms of The Information Standard.
- Updated April 2014To be reviewed April 2017