Nearly 1 million Americans are living with Parkinson's disease, a brain disorder that makes it difficult for a person to control their movements. That can cause symptoms such as shaking, stiffness, and challenges with balance and coordination.
While there’s no cure for Parkinson’s disease, medications help many patients control their symptoms. But medicines don't always have the desired effect. As a neurosurgeon, I have seen deep brain stimulation (DBS) help relieve symptoms and improve quality of life when medication is not enough.
DBS is a surgical procedure. Electrodes are implanted into the brain and connected to a small electrical device, which is placed in the chest. The electrodes and device work together to deliver painless stimulation to specific areas in the brain. The stimulation can correct rhythms in the brain that help control Parkinson's symptoms such as tremor, rigidity, and slowness of movement.
But before opting to undergo the procedure, it’s important for someone with Parkinson’s and their loved ones to learn about DBS and the kinds of improvements they can expect to see.
These are the facts and benefits I like to discuss, along with answers to some of the most common DBS questions.
How DBS works
DBS involves three surgically implanted components:
- The lead, also called the electrode. This is a thin, insulated wire implanted in the brain through an opening in the skull. The electrode uses pulses that change the brain’s electrical activity to improve motor symptoms. Prior to surgery, a patient will undergo imaging tests to determine the precise area where the lead will be placed.
- The impulse generator battery (IPG): This is a small device, similar to a pacemaker, that is implanted under the skin, usually near the collarbone. It sends electrical pulses through the extension and electrode to the brain.
- The extension. This is a wire connecting the lead to the IPG. It's passed under the skin of the head, neck, or shoulder.
After a patient has healed from surgery, their devices are programmed by their neurologist to ensure that the electrical pulses target the motor symptoms as effectively as possible. Getting the combination of programming and medications just right can take a few months, and I tell my patients that it may take up to a year for them to experience the greatest benefits.
The benefits of DBS
DBS offers continuous relief of symptoms
The best candidates for DBS are patients who get some symptom control from medication (levodopa) but are still experiencing symptoms between doses. DBS can offer continuous symptom control, making a patient less prone to these challenging "off" times.
DBS is generally considered low-risk, and can have great outcomes
No major changes are made to brain tissue during DBS, and it can be very effective at lessening symptoms.
A DBS procedure involves implanting devices that can disrupt problematic signals in areas of the brain responsible for movement.
DBS has a long track record of being both low risk and effective. It was first approved to treat Parkinson's disease tremors in 1997, and has since been used in more than 160,000 people worldwide for various neurological conditions, not just Parkinson’s.
It's a long-term option, but it doesn't have to be permanent
DBS devices can be easily removed if a person experiences undesirable side effects or if they want to try another treatment in the future.
Frequently asked questions about DBS
Here are some of the most common questions I hear from patients and their loved ones.
What are the risks of DBS?
DBS is considered a low-risk procedure, but it's important for patients to be fully informed before undergoing surgery.
It's possible to experience short-term confusion or trouble balancing after surgery. Some patients may also notice that stimulation causes numbness or tingling, behavioral changes, balance or speech problems, vision problems, or a sensation of "pulling" in the muscles. Over time, DBS devices can erode or break down and would need to be replaced through another surgery.
Rarely, the surgery itself could cause headaches, seizures, or temporary pain, as well as bleeding or brain infection.
Can DBS cure my Parkinson's?
Like other available Parkinson's treatments, DBS is not a cure for Parkinson’s, and it won’t slow the disease’s progression. However, studies show that the benefits of DBS can last for five years or longer. I've seen firsthand how it can greatly improve a patient's quality of life, and in some cases even help them live longer.
Do I still need to take Parkinson's medicine if I have DBS?
Most patients with DBS will see a significant improvement in their symptoms. They’ll still need to take some medications, but the dosage is typically much lower, and the medications will be less likely to cause side effects.
How can I know if DBS will work for me?
Patients who reap the biggest benefits are those who respond well to individual doses of levodopa and have good mobility during their "on" periods.
Before I perform surgery, I work with each patient to determine whether DBS will help them in particular. This neuropsychological assessment process is extensive and can take several months. But it's worth it to ensure that DBS is a good therapy for them.
Take the next step
If you are living with Parkinson’s, the right treatment can vastly improve your quality of life. Call 800-TEMPLE-MED (800-836-7536) or schedule an appointment online to have a consultation with one of the Parkinson’s experts at the Temple Health Movement Disorders Program.