This page covers deep brain stimulation, a potential treatment for adults whose seizures can’t be controlled by anti-seizure medication and who can’t have other surgeries.
What is deep brain stimulation?
Deep brain stimulation (DBS) is a treatment in which specific areas in the brain where seizures are occurring are stimulated electrically.
How does it work?
In DBS, small holes are drilled into your skull, and electrodes are inserted and placed deep into a part of the brain called the thalamus.
The thalamus is a small structure, just above the brain stem. It regulates sleep, alertness and wakefulness, and also plays an important part in our senses and movement.
The electrodes connect by wires to a small electrical stimulator – also known as a pulse generator or neurotransmitter – implanted under the skin on your chest. The wires pass under the skin behind your ear and down your neck.
The aim of DBS is that electrical stimulation will stop abnormal electrical activity in your brain and reduce seizures.
The electrical stimulator can then be programmed to adjust the intensity and rate of the electrical stimulation to the leads in the brain.
About a month after the operation, the neurosurgeon uses a programming unit to turn the electrical stimulator on, adjust the stimulation and monitor activity.
You’re given a hand-held programmer about the size of a mobile phone. You can use this to turn the DBS on and off, check battery status, adjust the programming and log a seizure event.
If you feel that a seizure is about to occur, you can use the programmer to activate the DBS treatment immediately.
Who is it for?
DBS therapy is only offered to adults whose seizures can’t be controlled by anti-seizure medication and who aren’t suitable for other types of surgery.
The procedure is only carried out in neurosurgery centres that specialise in managing epilepsy.
However, the evidence is limited for how effective DBS is at stimulating the thalamus, or for how safe it is.
When it is used to stimulate the thalamus, regular checks are needed to see how well it’s working or if there are any problems. This is because there are concerns about long-term effects and complications.
At present, DBS can only be used on other parts of the brain in medical research.
Is DBS right for me?
Patients for DBS are selected by a team of epilepsy specialists, including a neurologist, neurophysiologist and neurosurgeon.
If you are selected for DBS, before you agree to have the procedure, your healthcare professional team should discuss carefully with you and, if you wish, your family:
- What’s involved in the procedure and the medical research behind it
- How to find out more about the procedure
- The benefits – and how likely you are to get them
- The risks or side effects – and how likely they are
- Your options, if you don’t want to proceed with DBS
- What happens if something goes wrong with the procedure
The National Institute for Health and Care Excellence (NICE) has published guidance on making decisions about your care.
What are the side effects of DBS?
Common side effects are:
- Pins and needles in the hands or feet
- Pain where the electrical stimulator is implanted
- Infection where the electrical stimulator is implanted
Overall, DBS therapy has low rates of short-term and long-term complications.
Can DBS cure epilepsy?
No, DBS will not cure epilepsy.
But, it’s hoped that it can significantly reduce seizures. Settings can also be adjusted to minimise side effects such as a tingling near the pulse generator.
How well DBS works varies from person to person.
You’re more likely to benefit from DBS if:
- You’ve had a magnetic resonance imaging (MRI) scan that doesn’t show any damage or other problems in your brain
- You have temporal lobe epilepsy
A clinical study reported that half of patients with DBS had at least a 41% reduction in seizures in the first year, improving to a 56% reduction in the second year.
The study also reported a reduction in the most severe seizure types.
The National Institute for Health and Care Excellence (NICE) has called for more research to show how effective DBS treatment is for people with epilepsy.
