About dystonia Diagnosis and treatment Deep brain stimulation Overview Deep brain stimulation (DBS) is a surgical procedure in which two thin, insulated electrodes are inserted into your brain. These electrodes are then connected by a wire under your skin to a battery usually implanted in the chest or in the abdomen. The battery operates similarly to a pacemaker, delivering targeted electrical pulses that block the signals causing the symptoms of dystonia. Process The process will usually involve: Assessment for suitability Scans Surgery (under general anaesthetic) Activation of the stimulator Several programming sessions for the stimulator Additional support (e.g. physiotherapy) if suitable Regular follow ups In some cases, follow up surgery (including to replace the batteries) Suitability DBS can be used for children and adults. It works most effectively for people who have an inherited (genetic) form of dystonia and those with idiopathic (no known cause) primary dystonia. It is usually only offered for those who have severe generalised dystonia, neck (cervical) dystonia or dystonic tremor when other treatment options (such as botulinum toxin injections and oral medications) have failed to provide adequate relief. A rigorous patient assessment and selection process is carried out prior to the operation. In addition to the type of dystonia, several other health and risk factors will be taken into account, which might mean that a patient may not be deemed suitable for treatment. Benefits The electrical currents delivered through the electrodes on both sides of the brain can have a beneficial effect on the involuntary muscle contractions caused by dystonia. As a result, the symptoms of dystonia such as abnormal movements and postures and/or dystonic tremor can be eased. In addition, DBS can reduce the pain caused by dystonia. Risks All surgical procedures carry a degree of risk both from the surgery and the introduction of anaesthesia. However, when complications do occur, they are usually mild and short-lived. The risks of the procedure should be discussed with the treatment centre before going ahead. The types of risks are: Stroke/ Intercranial bleeding / Hemiplegia Seizures Infections Malfunction of the device Fracture of the lead Speech problems Stimulator stops working Success DBS can have a significant effect in easing the symptoms of dystonia but it is important to go into the operation with realistic expectations. After DBS some patients are able to stop receiving other treatments for their dystonia, but many patients do need to continue receiving botulinum toxin injections and/or oral medication. Access Referral to DBS can only be made by a consultant (adult or paediatric) specialising in movement disorders. To get the procedure approved, they will need to confirm that you meet the clinical criteria and that all appropriate alternative treatment options have been ruled out. Once this is done, the procedure, battery replacements and other follow-up support should be funded by the NHS. There are several specialist treatment centres across the UK that can provide DBS for dystonia.