Welcome to the University of Colorado Deep Brain Stimulation Program. Providing you with the highest level of care and meeting your goals are our top priority.
What is Deep Brain Stimulation?
Deep Brain Stimulation (DBS) is a surgical treatment for movement disorders that uses implanted electrodes to deliver continuous high frequency electrical stimulation to deep structures of the brain involved in motor control.
DBS is not an experiment treatment; it has been used to treat movement disorders for more than 30 years and there are more than 5,000 new devices implanted annually in patients around the world. In the USA, DBS is FDA approved for treatment of Parkinson’s disease (PD) and Essential Tremor (ET).
How does DBS work?
The programming of the DBS must be done by a specialty-trained and experience clinician. This is usually a movement disorders neurologists or trained advanced practice provider. There are multiple stimulation options that can be programmed by you clinician. Because of the complexity of DBS systems and the disorders that are treated with DBS, the programming is complicated. Finding the optimal stimulation settings might take three to six months.
The decision regarding DBS surgery in each patient is done by a multidisciplinary team of experts who carefully weight the risks and benefits ratio to make sure the expected improvements after the surgery will outweigh risks of the surgical procedure. At the University of Colorado this team includes a stereotactic neurosurgeon, movement disorders neurologist with expertise in DBS, neuropsychologist, neuroradiologist, rehabilitation physician, speech and physical therapist, and psychiatrist (in select cases).
During standard DBS surgery, the patient is awake and participating in the testing procedures. Asleep, MRI-guided technique can be used in selected cases. The University of Colorado is the only center in the region where this option is available. Surgery is usually done on one side of the brain at a time. This improves accuracy of implantation and patients generally tolerate it better.
The pulse generator is implanted in a separate procedure. There are currently three different systems that are approved for implantation in USA. Each has its own advantages and this variety gives doctors and patients more options.
What are the indications for DBS surgery?
In Parkinson’s disease:
- Diagnosis of advanced, levodopa-responsive idiopathic Parkinson’s disease (PD).
- Presence of motor fluctuations (early or sudden wearing off medications, inconsistent and unpredictable effect, troublesome dyskinesia) despite best medication management.
- Parkinsonian tremor that causes disability despite best medication management.
The expected improvements in PD are:
- Decrease or elimination of motor fluctuation, off time, and dyskinesia.
- Decrease doses and frequency of medications.
- Improvement in tremor, slowness of the movements and muscle stiffness.
- Overall quality of life.
It is important to remember that DBS is not a cure for PD. It helps only motor function and does not improve other non-motor aspects of PD.
In Essential Tremor:
Tremor-causing disability despite therapeutic doses of tremor medications or inability to take medications due to intolerable side effects.
In Dystonia:
Dystonia movements or postures cause disability despite therapeutic trials of medications and botulinum toxin injections.
Where can I learn more?
For Patients Considering DBS
The Process
Your neurologist will refer you to our center for a DBS evaluation. Our DBS Intake and Access Coordinator will contact you to schedule all your appointments for evaluation at the UCHealth Anschutz Outpatient Pavilion at the Anschutz Medical Campus.
Once your appointments are complete, your team of experts will meet to decide if you are a suitable candidate for DBS surgery. Many factors are weighed when we are making this decision. The final decision is made by the whole team.
We have streamlined our evaluation process to be sure we are choosing only candidates appropriate for DBS. Our goal is to have your evaluation completed within two days and a decision on if you are an appropriate candidate for DBS within two weeks of your last evaluation.
During your evaluation process, you will see the following specialists:
- Functional-trained neurosurgeons
- Movement Disorders Neurologist
- Neuropsychologist
- Neurophysiologist
- Neuropalliative Care
- Physical Medicine and Rehabilitation
- Neuroradiology
You will be guided throughout this process by the DBS Intake and Access Coordinator and the DBS Nurse. Together, they will explain the evaluation process and assist you in scheduling all your evaluation appointments.
If you are not a candidate for DBS surgery, know that this decision was made by a team of trained experts who looked at all potential risks and benefits. If you are not a candidate, you can schedule an appointment with one of our movement disorders specialists to discuss other treatment options.
If you are a candidate for DBS surgery, our Intake and Access Coordinator will contact you to schedule a pre-surgery appointment. We will make sure all your questions are answered during this appointment. Then our DBS surgery scheduler will contact you to schedule your surgery appointments.
After Surgery
After surgery, the patient will be scheduled for an initial programming appointment. This appointment is longer than a regular appointment.
For Referring Providers
To refer a patient for an advanced therapy evaluation (e.g. deep brain stimulation), please fax a referral and demographics information to our secure fax line: 720-848-0015.
Providers within the UCHealth system can refer patients through Epic by referring to AMC Neurology and then to Movement Disorders – Advanced Therapies subspecialty.