What Is Deep Brain Stimulation?

We don’t think of ourselves as anything like electrical devices, but there are actually some similarities. Really? The nervous system communicates through electricity. Wait—doesn’t the body run on chemicals? Yes, it does but there’s no contradiction: Our bodies use chemicals to produce electricity, the same electricity that powers your smartphone.

In several illnesses, the complex electrical exchanges that give us our lives go slightly off. Modern medicine is beginning to learn how to treat an electrical problem directly with electricity as an alternative to medication.

Deep brain stimulation (DBS) is one example.

DBS can treat involuntary muscle contractions (dystonia), epilepsy, essential tremor, obsessive-compulsive disorder, Parkinson's disease, and serious depression. More than 160,000 people with neurological conditions have been treated by DBS, the American Association of Neurological Surgeons reports.

It has shown promise for the worst cases of depression that don't respond to medications. The better-known electricity-based treatment, electroconvulsive therapy (ECT), has remission rates of 60 to 90 percent, but relapse rates are high, and repeated treatments have cumulative cognitive side effects that many won't tolerate. Other options are repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS).

DBS is also helpful for Parkinson's, a condition in which nerve cells in the brain don't produce enough of a brain chemical called dopamine to trigger the right electrical response. A diagnosis of Parkinson’s is terrifying—the disease gets worse over time, and you don’t know which symptoms will appear or when. Kay Marzotto couldn’t tie her shoes when she asked doctors in Boston for help and heard she probably had Parkinson’s. After two years of searching, she traveled from her home in Pittsfield, Mass. to Albany Medical College and undertook a DBS surgery. She now can hike and bowl, the hospital reports.

What is deep brain stimulation (DBS)? If you opt for DBS, you agree to have surgeon plant electrodes in your brain that generate electrical impulses. Each electrode is a thin insulated wire the surgeon inserts through a small opening in the skull and steers into a specific spot in the brain. An extension wire, running under the skin of the head, neck, and shoulder, connects electrodes to a programmable generator. The generator is usually installed under the skin of the chest.

When should you consider DBS? You might consider DBS if your symptoms are interfering with your life because they can’t be controlled by medication or the side-effects are intolerable.

What are the advantages of DBS? The placing of the electrodes is customized for each patient. The amount of electricity—and hence stimulation—is also customized and adjusted over time to prevent side effects and make the treatment more effective. The device is always with you, day and night, offering continuous symptom control.

You can still participate in other treatments that might become available.

DBS is reversible—you can turn off the device.

What are the risks of DBS? Electrodes usually don’t change the surrounding brain tissue, but the electrode can migrate. There is a 1 percent risk of brain hemorrhage, including stroke. The device may not help all symptoms or it might malfunction. Some people get headaches, temporary tingling in the face or limbs, speech or vision problems, and lose their balance.

The research behind DBS is relatively new—but beginning to accumulate. For example, a three-year multi-site trial appeared in 2012 concluding that the improvements in patients receiving DBS for Parkinson’s was stable. In 2014, surgical guidelines appeared for treating patients with OCD, in an overview concluding that DBS on both sides of the brain offered more improvement than a sham treatment (these treatments serve the function of a placebo in a test of medication, checking whether the patient improves simply because he feels hopeful, or because of the treatment itself). Just this year, new research appeared testing various targets in the brain to help the worst cases of depression.

As with any surgery, the risks increase in people age 70 and older or if you have heart disease or high blood pressure.

A version of this post appears on Your Care Everywhere.