Deep brain stimulation (DBS) may be helpful in severe cases of tardive dyskinesia that doesn’t respond to other treatments.

Tardive dyskinesia (TD) causes involuntary movements of the tongue, neck, face, trunk of the body, or limbs. The condition usually comes from the long-term use of certain medications. Severe symptoms of TD can greatly affect someone’s quality of life.

Deep brain stimulation (DBS) is an emerging treatment for TD. DBS has a significant history of use across other conditions such as Parkinson’s disease and epilepsy, but studies for its use in TD are limited. The treatment shows promise and might be a safe and effective option for people whose TD is not well managed with first-line treatments like medication.

Deep brain stimulation (DBS) is a minimally invasive technique where a small wire is placed inside the brain.

The tip of the wire is placed on the specific area of the brain that’s causing symptoms. The wire is attached to an implantable pulse generator (IPG) placed under the skin by the collarbone, chest, or abdomen. The IPG sends pulses along the wire to change the electrical activity of the brain where symptoms start.

People who undergo DBS must have several follow-up visits to a neurologist after the device implantation. This is in part to find the optimal programming of the device’s pulses to work best for a specific individual.

DBS acts on areas of the brain thought to be overactive during the involuntary movements associated with tardive dyskinesia.

Tardive dyskinesia happens after the long-term use of certain medications, specifically dopamine receptor agonists. Researchers have a few theories as to why this long-term use can lead to tardive dyskinesia.

One theory is that the long-term blocking of dopamine receptors can lead to changes in how information is transmitted in the brain. Parts of the brain associated with involuntary movements can become more active.

DBS might reduce the release of a brain chemical in these overactive areas of the brain, leading to fewer tardive dyskinesia symptoms.

DBS is still being studied for use in people with tardive dyskinesia. It’s currently an option only in cases of severe and chronic tardive dyskinesia where prior treatments have not worked. First-line treatments for tardive dyskinesia include the medications valbenazine (Ingrezza) and deutatrabenazine (Austedo).

Studies on deep brain stimulation in tardive syndromes have supported the conclusion that the treatment shows promise. A 2018 review of studies found symptom improvement across a total of 117 people treated with DBS for tardive syndromes. Of those 117 people, only four had tardive dyskinesia, while 113 had tardive dystonia.

Researchers have noted the need for further clinical trials to conclude that DBS is effective in tardive dyskinesia, but some conclude that the procedure may be safe.

According to the American Association of Neurological Surgeons (AANS), people are candidates for deep brain stimulation if:

  • symptoms substantially reduce quality of life
  • symptoms remain uncontrolled even with the use of medications
  • side effects of current medications are intolerable

In addition to meeting these criteria, individuals undergo extensive medical evaluation before deep brain stimulation is recommended.

People with tardive dyskinesia are potential candidates for DBS if they have:

  • significantly impairing symptoms that have continued for at least one year
  • no satisfactory response to the medications clozapine or tetrabenazine for four weeks at the highest tolerable dose

A healthcare professional might not recommend DBS even in these cases if a person has other medical conditions, depressive symptoms, significant cognitive impairment, or unstable mental status.

Although quite new for tardive dyskinesia, deep brain stimulation is an established treatment. A 2019 paper states that more than 160,000 people have had the procedure. It’s a treatment option for a number of conditions, including epilepsy and Parkinson’s disease. The procedure is reversible, as doctors can take out the IPG.

Deep brain stimulation does come with risks. The risks might occur at the time of the device implantation surgery or during stimulation. It’s also possible that the components of the stimulation device break down over time and must be replaced through surgery.

Risks from surgery include:

  • brain hemorrhage
  • infection in the brain
  • bleeding and swelling of brain tissue
  • malfunction of the IPG device
  • headache
  • seizures
  • worsening of mental or emotional state
  • temporary pain following the procedure

Risks during stimulation include:

  • face or limb tingling
  • sensation of muscles pulling
  • loss of balance
  • problems with speech or vision

One author notes that in a small 2018 clinical trial of DBS versus sham treatment for TD, adverse events occurred in 10 out of 25 people who received either DBS or sham treatment. Those events included gait disorders, confusion, skin erosion, pulmonary embolism, and trouble speaking (dysarthria).

Deep brain stimulation is an emerging treatment for tardive dyskinesia.

Clinical trials have been small, but the procedure shows promise to reduce symptoms in people with severe, refractory TD who do not find relief from medications. DBS is an established treatment for other conditions, including epilepsy and Parkinson’s disease.