Mind Over Muscle: Beat Parkinson’s With Deep Brain Stimulation
About Parkinson’s Disease
Parkinson’s disease (PD) is a chronic neurological disorder that affects the control of movement. Symptoms of PD include uncoordinated movements, tremors, and slowness to normal activities like walking and talking. Your motor skills are affected when some of your brain cells die and are unable to produce dopamine. Dopamine is a chemical that helps your neurons talk to each other. Dopamine helps the transmitted messages make your muscles and nerves work together seamlessly.
Medications and medical treatments can help control tremors and other symptoms of Parkinson’s. Deep brain stimulation (DBS) is a treatment method that your doctor might recommend if less invasive therapies aren’t giving you enough relief from symptoms.
What Is Deep Brain Stimulation?
Deep brain stimulation is a type of brain surgery that stops impaired electrical activity from occurring in three main areas of the brain:
- subthalamic nucleus
- globus pallidus
With low levels of dopamine, these sections of your brain can’t process nerve impulses correctly. The impaired electrical signals lead to slow, jerky, and uncontrolled movement, stiff muscles, and walking difficulties. The excess movement can be exhausting. DBS sends new electrical signals to the brain. The new signals interfere with the faulty impulses, which can improve Parkinson’s symptoms. Healthy brain cells are not damaged during DBS.
When Is DBS Used?
Many people with Parkinson’s respond well to drug therapy. A medication called levodopa helps your brain cells make more dopamine. With an abundance of dopamine, many of the most life-altering symptoms of PD improve, including tremors. However, according to the National Institute of Neurological Disorders and Stroke (NINDS), about one quarter of people with Parkinson’s do not see positive results with levodopa. DBS is an alternative treatment to consider when drugs do not help calm the tremors, muscle rigidity, and bradykinesia (slowness of movement).
Am I a Candidate for DBS?
Deep brain stimulation is a “last resort” type of treatment for Parkinson’s. Other remedies are always tried first since DBS is invasive. If medications do not control your symptoms, you might be a candidate for the procedure if you meet other criteria, including:
- You have had PD for at least five years.
- Your symptoms fluctuate in severity (on/off patterns).
- Your symptoms respond to levdopa, but not for as long as you’d like.
- You have tried a number of different PD medications without adequate success.
- Your symptoms affect your everyday activities.
How Does DBS Work?
Deep brain stimulation is a surgical procedure. Your surgeon implants a neurotransmitter, a small box with wire leads, just below your collarbone. The leads are threaded under your skin up toward your scalp. The surgeon makes a tiny hole in your skull, in which the wires are inserted. The tip of the wire is implanted into a section of the brain called the “target center.” The target center is the area from which most of the faulty impulses originate. Your doctor uses magnetic resonance imaging (MRI) to find the spot that is the center of your Parkinson’s symptoms.
You’ll need to be awake during the surgery so your doctor can test the device and make sure it works. Local anesthetics and sedatives make you sleepy and relaxed, and allow you to avoid feeling pain during surgery.
Deep Brain Stimulation and MS Brain Lesions
Multiple sclerosis (MS) is a neurological disorder that can produce some similar symptoms to Parkinson’s disease. MS brain lesions caused by the erosion of myelin, a protective coating of the nerves, can cause tremors and problems with mobility. If you’ve got severe tremors relating to MS that aren’t controlled with medication, you might be a candidate for DBS. Although the treatment shows promising results, the University of Wisconsin Hospital explains that deep brain stimulation for MS is still in experimental stages and limited availability.
Risks of Deep Brain Stimulation
All surgical procedures have risks, including deep brain stimulation. Some of the risks associated with DBS are minor, temporary, and fixable:
- irritation where the neurotransmitter and leads are inserted
- numbness and tingling when the neurotransmitter is activated
- low battery in the neurotransmitter (a battery lasts about five years)
Other risks are more serious and must be dealt with immediately:
- infection, bleeding, or stroke
- depression and cognitive problems
- impaired balance and increased risk of falling
Speak to your doctor if you do not feel well or “right” during your recovery period. You’ll be in the hospital for several days’ worth of observation after the DBS device is implanted.
Deep brain stimulation is not a cure-all for Parkinson’s symptoms. It’s common for people to take medication in addition to DBS as a sort of tandem treatment.
However, many Parkinson’s patients find that DBS helps them retain a positive quality of life. Studies published in JAMA suggest that DBS in the globus pallidus and subthalamic nucleus gives people with PD an average of five hours of “on” time without involuntary movement, tremors, or muscle stiffness. DBS in the thalamus as the target center is most effective in reducing tremors, but not bradykinesia or rigidity.
- Deep Brain Stimulation. (2012). UW Health, University of Wisconsin Hospital, Madison. Retrieved August 27, 2013, from http://www.uwhealth.org/health/topic/otherdetail/deep-brain-stimulation/hw90970.html
- Deep Brain Stimulation. (2013). National Parkinson Foundation. Retrieved August 27, 2013, from http://www.parkinson.org/Parkinson-s-Disease/Treatment/Surgical-Treatment-Options/Deep-Brain-Stimulation
- Deep Brain Stimulation. (2013). University of Maryland Medical Center. Retrieved August 27, 2013, from http://umm.edu/programs/neurosciences/treatment-programs/deep-brain-stimulation
- Deep Brain Stimulation for Parkinson's Disease Information Page. (2012). National Institute of Neurological Disorders and Stroke (NINDS). Retrieved August 27, 2013, from http://www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_brain_stimulation.htm
- Parkinson's Disease Information Page. (2013). National Institute of Neurological Disorders and Stroke (NINDS). Retrieved August 27, 2013, from http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm
- Weaver, F.M. et al. (2009, January 7). Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA, 301(1), 63-73. Retrieved August 27, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/19126811