What you can expect

During the surgery

In general, here's how surgery for deep brain stimulation works:

• Brain surgery. For the brain surgery portion, your care team fits you with a special head frame to keep your head still during the procedure (stereotactic head frame). Then, team members use neuroimaging (brain MRI or CT) to map your brain and identify the area in your brain where they'll place the electrodes.

  In most cases, the electrodes will be placed while you're awake and alert. This is to be sure the effects of stimulation can be tested fully. If you're awake for surgery, you'll be given a local anesthetic to numb your scalp before the procedure, but you won't need an anesthetic in your brain itself because the brain has no pain receptors. In some cases, surgery can be done under general anesthesia so that you'll be unconscious.

  Your surgeon implants a thin wire lead with a number of contacts (electrodes) at the tips into a specific area of your brain. Or one lead is implanted into each side of the brain (for a total of two leads). A wire runs under your skin to a pulse generator (neurostimulator) implanted near your collarbone.

  During surgery, both the neurologist and the surgeon carefully monitor your brain to help ensure correct electrode placement.

• Chest wall surgery. During the second portion of the surgery, the surgeon implants the part of the device that contains the batteries (pulse generator) under the skin in your chest, near your collarbone.

  General anesthesia is used during this procedure. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated pulse generator.

  The generator is programmed to send continuous electrical pulses to your brain. You control the generator, and you can turn it on or off using a special remote control.

After the procedure

A few weeks after surgery, the pulse generator in your chest is activated in your doctor's office. The doctor can easily program your pulse generator from outside your body using a special remote control. The amount of stimulation is customized to your condition, and may take as long as four to six months to find the optimal setting.

Stimulation may be constant, 24 hours a day, or your doctor may advise you to turn your pulse generator off at night and back on in the morning, depending on your condition. You can turn stimulation on and off with a special remote control that you'll take home with you. In some cases, your doctor may program the pulse generator to let you make minor adjustments at home.

The battery life of your generator varies with usage and settings. When the battery needs to be replaced, your surgeon will replace the generator during an outpatient procedure.