Deep Brain Stimulation
DBS is a surgical treatment option for patients that continue to have medication responsive symptoms. Although brain surgery may sound scary and does have some risks, DBS has improved the lives of thousands of people living with Parkinson’s disease.
DBS can be thought of as a brain pacemaker in which electrical stimulation or impulses are applied to specific areas of the brain involved in motor control. For Parkinson’s, these brain regions are the globus pallidus internus (Gpi) or the subthalamic nucleus (STN). Special neurosurgical procedures allow implantation and placement of these electrical leads and wires with great precision. After surgery, electrical stimulation can be changed to tailor the treatment to a person’s symptoms.
What gets better with DBS?
DBS treats rigidity, slowness in movement, dyskinesia and tremor. The best candidates are people that still get a good response to dopamine medicines and can function well when in the medicine on state, yet have difficulty with moving when medicine wears off. In general, DBS can help people with advancing Parkinson’s disease that are noticing the following difficulties:
- Tremor that is not adequately controlled with medicine
- Motor Offs. DBS can increase on time and reduce off time. ‘Off periods’ are times when the effect of medication has worn off. This may mean taking increasing doses of medicines or adding additional medicines to try and smooth out the effect of therapy. As medicines are increased dyskinesia or involuntary movements can increase.
- Some forms of dystonia or painful muscle contraction, cramping and pain
What does not get better with DBS?
DBS is as ‘good as medicine’. The difference is at certain stages of Parkinson’s medicines are limited in their ability to reduce off time and minimize dyskinesia. As noted above DBS can extend the on time give you greater freedom of movement throughout the day. DBS does not treat movement problems that also do not get better with dopaminergic medicines such as L-dopa. Examples of the symptoms that may not respond to DBS are:
- Gait freezing
- Serious walking problems, imbalance or postural instability
- Speech problems
- Swallowing problems
- Cognitive problems
Who is a good candidate for DBS?
DBS is an effective therapy in midstage disease when motor off times, dyskinesia and/or tremor are a problem.
Patients that might be good candidates for DBS are people that can answer “yes” to the following statements:
- Levodopa still helps control the movement symptoms of Parkinson disease. I am able to move when my medicine is working. My daily routine will improve if the time that my medicine is working is extended.
- My medicine doesn’t last from dose to dose or wearing off before next dose is due. I have trouble moving mostly at this time in my medicine dosing.
- My medicine still works but isn’t controlling my tremor
- Dyskinesia is limiting my activities, is bothersome or causing pain
- My mind is still sharp and I am not having hallucinations
- My mood is not depressed or anxious
- I can live with an implanted device in my brain or body
- My family is supportive and I can travel for DBS appointments as necessary
What is needed to determine if I am a candidate for DBS?
A thorough evaluation will insure that you are a good candidate for DBS, will minimize risk and better insure that surgery meets your expectations. The following evaluation(s) is commonly performed:
- Neurology consult by a physician specialized in Parkinson’s and DBS therapy. This insures that you have the right diagnosis, and are seeking surgery at the right time/stage of your disease.
- Neuropsychological testing. This determines whether a person has significant cognitive or emotional problems that are a concern or may worsen with surgery.
- ON-OFF L-dopa testing. This exercise usually requires a person to be evaluated without medicine first thing in the morning and once again after medicine is taken. This step provides crucial information further defining what surgery will or will not improve.
- Rehabilitation therapy such as speech, occupational or physical therapy. This may be needed for people experience significant problems to establish a baseline before surgery and to set up a post-surgery treatment plan.
- Neurosurgery consult.
- Primary care and/or psychiatry consult may be needed if other medical or psychiatric problems are identified to reduce negative consequences of these problems on surgery.
See the Resources section for books and information about PD and DBS
- DBS A Patient Guide to Deep Brain Stimulation is a complete source of information for people interested in or already livng with DBS.
Monique L. Giroux, MD
Guest Blogger, Former Medical Director of NWPF