DBS for Essential Tremor
DBS is considered when patients with persistent and severe tremor are not receiving significant benefits from medications or the side effects are too severe.
We are experts in deep brain stimulation and spinal cord stimulation.
The Center for Neuromodulation at The Ohio State University Wexner Medical Center is one of the nation’s leading centers in developing neuromodulation treatments for a wide range of diseases and conditions. Neuromodulation, which involves the use of implantable devices that alter nervous system activity through the use of electrical stimulation, is one of the fastest-growing medical specialties.
Our neuromodulation team is among the most experienced in the country. We perform deep brain stimulation for treatment of Parkinson’s disease, essential tremor, dystonia and obsessive compulsive disorder. We also perform spinal cord and peripheral nerve stimulation for treating patients with occipital neuralgia failed back syndrome, radicular pain syndrome, post-laminectomy pain, peripheral neuropathy and complex regional pain syndrome.
Why choose the Ohio State Center for Neuromodulation?
Nationally Recognized: Ohio State is routinely recognized for our excellence in neurosurgery, neurology and neuromodulation.
Unique in the Region: Ohio State is the only healthcare facility offering deep brain stimulation (DBS) in central Ohio.
Most Experienced Neuromodulation Team in the United States: The physicians of the Center for Neuromodulation at The Ohio State University Wexner Medical Center perform thousands of neuromodulation surgical procedures each year.This team is led by world-renowned neurosurgeon Ali Rezai, MD, a leading pioneer in DBS surgical therapies, who has performed more than 1,900 DBS cases for patients with Parkinson’s disease, essential tremor, dystonia, traumatic brain injury and obsessive compulsive disorder.
Research: We are exploring how deep brain stimulation and spinal cord stimulation can treat other chronic disabilities and diseases.
Deep Brain Stimulation
What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a commonly performed surgical procedure for patients with Parkinson’s disease, essential tremor or dystonia. DBS treats a variety of disabling neurological symptoms including tremor, rigidity, stiffness, slowed movement and walking problems.
DBS electrodes are implanted into the brain and connected to a small pacemaker-like programmable device that has been implanted into the chest or abdominal wall (no exposed hardware). The electrodes deliver tiny electrical signals that calm abnormal brain signals, alleviating disabling symptoms, such as tremors, and restoring function to the patient.
We frequently treat patients with these diagnoses:
DBS for Parkinson's Disease
DBS is considered when a patient has idiopathic Parkinson’s disease and one of these issues:
- Debilitating hand or leg tremor that fails to respond to medications
- Idiopathic Parkinson's disease with continued good benefit from treatment with medications, but with frequent return of disabling rigidity, slowness of movements, tremor due to "on-off" fluctuations or excessive uncontrollable movements called “dyskinesia”
- Idiopathic Parkinson’s disease but failure to tolerate all Parkinson’s medications due to severe side effects
DBS for Dystonia
DBS is considered when a patient has significant debilitating symptoms of primary dystonia and has failed to respond to oral medication, botulinum toxin therapy (Botox) and other treatment modalities.
DBS for Obsessive Compulsive Disorder
DBS is considered when a patient has severe OCD symptoms that have lasted for more than five years and have failed to respond to medication and cognitive therapies.
Learn how DBS helped these patients
Pat explains the surgical process.
Pat, a tremor patient, was nervous about surgery until her surgeon explained the process.
Lon talks about his DBS surgery.
Lon, a patient with Parkinson’s disease, shares his journey with deep brain stimulation.
How do I become a DBS candidate?
If you are interested in becoming a candidate for deep brain stimulation at Ohio State’s Center for Neuromodulation, you must have a physician referral. Contact your healthcare provider for an initial evaluation and referral to Ohio State’s Center for Neuromodulation. Your healthcare provider will complete a referral form and submit it to our center. After reviewing your records, our office or your referring provider will contact you regarding scheduling an appointment.
Find out if you're a candidate for DBS
Screening and Evaluation
Referred patients who meeting the appropriate medical criteria will be called to schedule an appointment at the Center for Neuromodulation for a DBS consultation. Screening and evaluation process include:
- You will receive an evaluation with a movement disorder neurologist and/or psychiatrist, functional neurosurgeon and nurse practitioner to assess various aspects of your disease, symptoms, progression, previous treatments and overall medical health.
- You will have brain imaging performed and reviewed by our neuroradiologist.
- You will have a comprehensive evaluation by a neuropsychologist. The neuropsychological testing helps to better understand your cognitive (thinking, memory, concentration, attention) status and provides a baseline for the team to monitor you over time.
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Our multi-disciplinary team regularly meets to discuss the details of your comprehensive evaluation to determine your DBS risk to benefit ratio. After your case is discussed at the DBS conference you will be notified of the best treatment options. These recommendations may include surgery, other therapies such as medication adjustments and individual rehabilitation program.
We work closely with you, your family members, your caregivers and your referring physicians to develop a comprehensive and holistic care plan.
If you are considering DBS, it is important to have realistic expectations about what symptoms may or may not improve. Additionally, your family and support structure need to be in place to help you with follow-up care and appointments.
Spinal Cord Stimulation
What is Spinal Cord Stimulation?
Spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) involves electrical stimulation of the spinal cord to interrupt pain signals from the spinal cord to the brain. It is a proven, safe and effective therapeutic approach for managing chronic pain of the neck, back, arms and legs, which may occur following spinal surgery. A medical device similar to a pacemaker, which is placed beside the spinal cord or peripheral nerve, is used to deliver mild electrical impulses before pain signals arrive. Instead of pain, patients feel a tingling sensation from the neurostimulation in areas where the pain is felt.
Who should consider SCS or PNS?
SCS or PNS can benefit you if you have chronic pain of the neck, back, arms and legs occurring as a result of spinal surgery. Some of the conditions treated include:
- Failed back surgery syndrome
- Post-laminectomy pain
- Peripheral neuropathy
- Complex regional pain syndrome (also known as reflex sympathetic dystrophy)
- Occipital Neuralgia
You may want to consider SCS when:
- Other treatment options have failed to adequately provide pain relief
- Your doctor understands what is causing your chronic pain
- Further traditional surgeries are not recommended
- You don’t have a serious, untreated dependence on pain medication
- You have passed a psychological evaluation
- You don’t have medical issues that would make surgery difficult
- You have had a successful neurostimulation screening test
Benefits
Overall benefits of SCS or PNS may include:
- Significant and sustained reduction in back and leg pain
- Improved ability to function and participate in activities of daily living
- Fewer oral pain medications
- Ability to stop the therapy by turning it off or surgically removing the SCS device
- Ability to adjust the therapy based on pain level
- With improvements in a person’s pain, the potential ability to participate in other forms of therapy to better manage the pain
How is SCS/PNS performed?
SCS/PNS is performed in two phases. A “trial” phase is done first to see if you can get pain relief from the device. This is normally done as an outpatient procedure , the electrodes stays in place for five to seven days. If there is pain relief, a permanent device is implanted, which requires another outpatient surgical procedure.
It is important to know that this procedure may reduce but not cure your pain. You may feel a tingling instead of the pain, and it may improve your ability to function.
You may want to consider SCS/PNS when:
- Other treatment options have failed to adequately provide pain relief
- Your doctor understands what is causing your chronic pain
- Further traditional surgeries are not recommended
- You don’t have a serious, untreated dependence on pain medication
- You have passed a psychological evaluation
- You don’t have medical issues that would make surgery difficult
- You have had a successful neurostimulation screening test
How can I be evaluated?
If you are interested in becoming a candidate for spinal cord stimulation or peripheral nerve stimulation, you must have a physician referral. Contact your healthcare provider for an initial evaluation and referral to Ohio State’s Center for Neuromodulation. Your healthcare provider will complete a referral form and submit it to our center. You will then be scheduled to receive a comprehensive screening and evaluation by our multidisciplinary team.
It is important to know that SCS may reduce but not cure your pain. You may feel a tingling instead of the pain, and it may improve your ability to function.
Patient Stories
Lon
Pat
Lon
Lon, a patient with Parkinson’s disease, shares his journey with deep brain stimulation.
Before Lon had deep brain stimulation (DBS), his days revolved around controlling the symptoms of Parkinson’s disease. Since having DBS surgery, his days are focused on what he enjoys, like running again for the first time.
Prior to his surgery, Lon’s symptoms began to escalate. He could feel tremors in his face, jaw, right hand, and he began to feel them in his legs. As Lon’s symptoms increased he was no longer able to type.
“If it continued it would probably be about half a year before I don’t think I would be able to work.”
Lon felt uncertain about his future, “Forty-some years old, maybe trying to apply for social security; I didn’t know what I was going to do,” he says.
Lon and his wife met with Dr. Park, a neurologist at The Ohio State University Wexner Medical Center. There they learned about DBS, a procedure that involves implanting tiny electrodes in the brain and a small pacemaker-like device in the upper chest. Thin wires then connect the device to the electrodes, delivering electrical pulses that blocked abnormal signals from the brain.
“You could tell that this was a process that mattered to Ohio State.”
Lon says that he feels lucky to have received fast treatment from the outstanding teams at Ohio State, who really understood what he was going through.
“Most of the time I don’t even notice that I have Parkinson’s.”
Thanks to the success of his surgery, Lon is running again for the first time since high school. “The DBS has allowed me to stay active, I lost 50 pounds,” he says.
“The change in my quality of life is night and day, I never thought I’d be back to this.”
Pat
Pat started to avoid social situations because of her tremor.
“I was avoiding more and more social situations because of my condition.”
Approximately six years ago, Pat started noticing tremors getting worse in her right hand. She didn’t think it was noticeable and kept it a secret from most people that she knew. But she began having difficulty grooming – doing her hair and putting on makeup. She also had trouble cooking and was no longer going out with friends in groups. “I was avoiding more and more social situations,” Pat explains.
About three years ago, Pat mentioned how the tremors were affecting her life to her family doctor. He started her on some medications. After trying a few different medications without much success, her doctor suggested that she should see a neurologist. “I remember they asked me to sign a form in the hospital and I really didn’t recognize my own writing it was so bad,” Pat relates. “So when I saw my family doctor the next time I said, ‘I guess it’s time to see a neurologist.’”
“I really feel very fortunate and blessed.”
“I really feel very fortunate and blessed that I found Dr. Rezai at exactly the right time … right when I needed him,” Pat says. Dr. Rezai explained in detail about how they would perform the surgery, how long she would be in hospital and what improvements she would likely see after surgery.
She was asleep for part of the surgery, but awake when they needed her to answer questions and perform certain tasks as they tested the device. “It was pretty awesome to be able to be able to write my name, hold a glass, touch my nose and all of these different things right there on the operating room table,” Pat explains. “In fact, I went to wipe away a tear when I wrote my name. And someone said ‘Why is she crying?’” Shannon, the certified nurse practitioner, said, ‘Haven’t you ever heard of tears of joy?’”
“I consider deep brain surgery like a miracle”
After Pat’s surgery, Pat recalls that her friends wanted to do bring meals over and she told them she really didn’t need help because of the tremendous improvements from her surgery. “I was able to eat soup and do everything with my right hand that I haven’t for a long time,” Pat relates. While she has her deep brain stimulation device on all day, she turns it off at night. “First thing when I wake up I turn it on and life is good again,” she says. “Many times I think it’s good that I do turn the device off because it gives me a reality check of what life would be like if I didn’t have the surgery.” Pat adds, “I’d do it again in a heartbeat. It has made such a difference. I just really feeI that I have my life back.” Sometimes when she’s eating a bowl of soup or carrying her coffee cup to the kitchen table, Pat remembers that she couldn’t do these things a year ago. “My friends will tell me it’s either magic or a miracle. And Pat concludes, “To anyone who is thinking of deep brain stimulation, I really consider it like a miracle.”
“It really makes me realize how fortunate I am that I have had the surgery.”
When Pat met recently with her neurologist, Punit Agrawal, DO, she told him,“I am doing great. It has been able six months since my last appointment and it has made such a difference in my life. Everything I go to do I just do naturally now.”
She demonstrated to Dr. Agrawal the amazing difference that DBS has made in her abilities. With the DBS turned off, her tremors are very evident. She can’t touch her nose without great effort and her writing is hardly legible. When the device is turned on, she can easily repeat the same tasks illustrating the effectiveness of DBS. “It makes me realize how fortunate I am that I made the decision to have the surgery.
“I feel as though I have my life back again.”
In retrospect, Pat acknowledges that she was more depressed than she realized because there were so many things she couldn’t do. “Initially, I didn’t think my condition was severe enough to warrant surgery,” she explains. Pat, who is a retired RN, was apprehensive initially about having brain surgery. “What really made all the difference in the world was my trust and confidence in my doctors.”
“Since the surgery, I feel as though I have my life back again,” Pat shares. “It’s probably one of the best decisions I’ve made in my life. I’ve had excellent results. In my estimation, my tremor has improved about 100 percent.”
Research
Research & Clinical Trials
Clinical trials are the safest and fastest form of research to identify medical therapies that work and improve health. Clinical trials, using human volunteers, can involve new or existing medications, devices, diagnostic and surgical procedures as well as new uses for existing therapies. Our researchers work closely with other experts across the university such as scientists, clinicians, biomedical engineers and physicians to bring new diagnostic and innovative treatments to our patients.
Our Team
The neuromodulation team comprises more than 40 specialists. Dr. Ali Rezai and his team are international leaders at the forefront of scientific discoveries and innovations in neuromodulation, such as development of MRI-compatible neurostimulators, an MRI-guided brain pacemaker implantation technique, closed loop sensing and monitoring and an external handheld neuromodulation device to treat headaches.
The team is among the first in the world to conduct clinical trials of neuromodulation treatments for psychiatric disorders, traumatic brain injury, obesity, Alzheimer’s disease, addictions, autism, quadriplegia, chronic pain, back pain, headaches, heart failure and other conditions.
Ali Rezai, MD
CEO, Neurological Institute
Director, Center for Neuromodulation
Stanley D. and Joan H. Ross Chair in Neuromodulation
Associate Dean of Neurosciences Professor, Neurosurgery and Neuroscience
A board certified neurosurgeon, Dr. Rezai’s clinical areas of expertise are the neurosurgical management of patients with severe movement disorders such as Parkinson’s disease, dystonia, tremor, psychiatric conditions such as depression and obsessive compulsive disorder, traumatic brain injury and chronic pain. Dr. Rezai’s research focuses on mechanisms of neurostimulation, delineation of abnormal brain circuitry underlying disease processes, as well as developing neuromodulation devices and novel therapeutic strategies for treatment of neurological disorders. He has been involved in pioneering the use of brain pacemakers for treating Parkinson’s disease, depression, obsessive compulsive disorder and traumatic brain injury. His current research focuses on developing neuromodulation therapies to treat migraine headaches, asthma, addictions, Alzheimer’s, obesity, post-traumatic stress disorders and autism.
Punit Agrawal, DO
Assistant Professor, Neurology
Dr. Agrawal has clinical interest in the use of deep brain stimulation therapy for the treatment of approved movement disorders including Parkinson’s disease, tremor and primary dystonia. He also is trained in and practices treatment of focal dystonia with botulinum toxin therapy. He is involved in clinical research trials for movement disorders and neuromodulation.
Cady Block, PhD
Assistant Professor, Psychiatry
Dr. Block is a neuropsychologist with expertise in neurocognitive and neuropsychiatric effects of neurological disease and injury. The neuropsychology team provides a critical perspective in the process of pre/post-surgical evaluation for neuromodulation intervention, as well as assessing the trajectory of neurocognitive changes associated with neurodegenerative, neurogenetic, neurovascular, and seizure disorders. Dr. Block is active in research, with special interest in postoperative cognitive decline and secondary effects on neuropsychological functioning including medication and medical burden, fatigue and disordered sleep, and motivational/expectancy effects. She is active professionally within clinical neuropsychology, holding leadership positions in the Society for Clinical Neuropsychology, International Neuropsychological Society, and American Academy of Clinical Neuropsychology.
Marcia Bockbrader, MD, PhD
Assistant Professor, Physical Medicine and Rehabilitation
Dr. Bockbrader’s clinical interests include acute inpatient neurorehabilitation after central nervous system injury from stroke, traumatic brain injury, cancer or spinal cord injury. Her research areas include recreational therapy interventions to enhance the rehabilitation process, neuromodulation to improve function and quality of life for patients with disabilities and innovative ways to use technology in neurorehabilitation and education.
Jennifer Bogner, PhD, ABPP
Chair, Research and Academic Affairs, Physical Medicine and Rehabilitation
Associate Professor, Physical Medicine and Rehabilitation
One of Dr. Bogner’s areas of research is the study of factors that are associated with long-term outcomes following traumatic brain injury. She is the co-principal investigator of the Ohio Regional TBI Model System, a study that follows individuals for many years after their injury to find out what factors determine the best outcomes. Dr. Bogner is also interested in the study of substance use disorders after brain injury.
Laura Boxley, PhD
Assistant Professor, Psychiatry
Dr. Boxley is a neuropsychologist, she assesses the cognitive and psychiatric symptoms associated with different medical illnesses such as neurodegenerative disease, cancer and acquired brain injury. She is passionate about neuropsychology because it can help improve diagnostic accuracy and provide solutions for treatment and management of illness. She also enjoys the opportunity to participate in multidisciplinary research with my colleagues in medicine and education.
Anthony Caparso, PhD
Research Scientist, Neuroscience
Dr. Caparso is a biomedical engineer who focuses on neural stimulation.
Barbara Changizi, MD
Professor, Neurology
Dr. Changizi cares for patients in the Movement Disorders Division of the Department of Neurology, where she treats Parkinson’s disease, Parkinsonian syndromes, tremor (including essential tremor, multiple sclerosis tremor), dystonia, ataxia and Tourette syndrome. She is an expert in botulinum toxin administration for dystonia, tremor, tics and hemifacial spasm.
John Corrigan, PhD, ABPP
Director, Rehabilitation Psychology Director, Ohio Valley Center for Brain Injury Prevention and Rehabilitation.
Dr. Corrigan is the project director for the Ohio Regional Traumatic Brain Injury Model System, a multicenter research program funded by the National Institute on Disability and Rehabilitation Research.
Erica Dawson, PhD
Assistant Professor, Psychiatry
Dr. Dawson chose to become a clinical neuropsychologist because of my interest in brain-behavior relationships. Neuropsychological evaluations help identify whether changes in thinking have occurred as a result of a medical illness or injury. What she enjoys most about being a neuropsychologist is the opportunity to help patients learn to work around their limitations with effective strategies and other forms of assistance.
Milind Deogaonkar, MBBS
Associate Professor, Neurological Surgery
Dr. Deogaonkar’s clinical areas of interest are deep brain stimulation for Parkinson’s Disease, movement disorders, spinal cord stimulation for pain, peripheral nerve stimulation for pain and intrathecal pumps for spasticity. His current research resides in neuromodulation, neural circuitry and functional neuroimaging.
Lynne Gauthier, PhD
Assistant Professor, Physical Medicine and Rehabilitation
Dr. Gauthier uses neuroimaging techniques to study the clinical effectiveness of constraint-induced movement therapy (CI therapy), which is used to treat hemiparesis (weakness on one side) resulting from stroke, cerebral palsy and brain injury. She works with individuals who have experienced brain injuries to aid them in overcoming emotional and physical challenges that can accompany recovery.
Michael Knopp, MD, PhD
Vice Chair of Research, Radiology
Novartis Chair of Imaging Research
Director, Wright Center of Innovation in Biomedical Imaging
Professor, Radiology
Assistant Professor, School of Biological Sciences, Neuroscience
Dr. Knopp is experienced in developing and validating new imaging methodologies with an interest in magnetic resonance imaging and positron emission tomography. His scientific focus has been imaging of angiogenesis (physiological process through which new blood vessels form from pre-existing vessels) and response assessment. His current research focus is on functional and molecular hybrid imaging-based assessment as well as validation of imaging methodologies as biomarkers.
W. Jerry Mysiw, MD
Director and Chair, Physical Medicine and Rehabilitation
Medical Director, Dodd Hall Rehabilitation Services
Bert C. Wiley, MD, Chair in Physical Medicine and Rehabilitation
Co-Director, Traumatic Brain Injury Program
Associate Professor, Physical Medicine and Rehabilitation
In addition to his clinical interests in the rehabilitation of people with traumatic brain injury and electromyography, Dr. Mysiw’s research has focused on improving functional outcome after traumatic brain injury and spinal cord injury.
Randy Nelson, PhD
Director and Chair, Neuroscience
Director, Brain Research Institute
Dr. John D. and E. Olive Brumbaugh Chair in Brain Research and Teaching
Professor, Psychology and Evolution, Ecology and Organismal Biology
Dr. Nelson’s research program addresses the effects of interactions among the nervous, endocrine and immune systems on health. He has published more than 300 research articles and several books describing studies in seasonality, behavioral endocrinology, biological rhythms, stress, immune function, sex behavior and aggressive behavior. His current studies examine the effects of light at night on metabolism, mood, inflammation and behavior.
Bradley Otto, MD
Assistant Professor, Otolaryngology – Head and Neck Surgery
Dr. Otto’s area of expertise includes the medical and surgical management of sinus disease as well as minimally invasive skull base surgery. As a member of the Comprehensive Skull Base Surgery Center, Dr. Otto is also interested in the development of new techniques and devices to treat complex skull base disorders.
Douglas Scharre, MD
Director, Division of Cognitive Neurology
Medical Director, Neurobehavior and Memory Disorders Clinics
Director, Neurodegenerative Disease Brain Tissue and Cerebrospinal Repository
Associate Professor of Neurology
Dr. Scharre conducts clinical research in dementia and mild cognitive impairment that has been funded by National Institutes of Health, foundations and industry. He has many active grants, including clinical drug trials using cognitive enhancers and behavioral therapies, functional neuroimaging studies using SPECT and MRI and screening for mild cognitive impairment and early dementia diagnosis. Dr. Scharre is the creator of the Self-Administered Gerocognitive Exam (SAGE), a brief pen and paper test used to identify mild cognitive impairment from any cause and early dementia.
Per Sederberg, PhD
Assistant Professor, Computational Memory Lab
Dr. Sederberg’s primary interests are the successes and failures of human memory. These interests motivate the work in the Computational Memory Lab, which has the overarching goal of developing a comprehensive theory of memory formation and retrieval that links the rich cognitive behavior to its underlying neural mechanisms.
Zachary Weil, PhD
Assistant Professor, Neuroscience
Dr. Weil’s research interests include basic and translational neuroscience that focuses on how environmental and temporal variables can interact with the immune, autonomic and neuroendocrine systems to control physiology and behavior. Additionally, he is focusing on how environmental variables can render organisms differentially susceptible to nervous system injuries and how these types of phenomena can be studied to help develop treatments for human diseases.
Nicole Young, PhD
Research Assistant Professor, Neuroscience
Dr. Young’s research areas include motor deficits and recovery of motor function and affective neuroscience (fear and anxiety). She is currently developing a method for flow fractionator for cell counting in homogenized neural tissue using flow cytometry.
Dr. Ali Rezai talks about our innovative neuromodulation program.