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Deep Brain Stimulation for Parkinson’s Disease

Overview

Deep brain stimulation (DBS) is a type of therapy used to relieve neurological symptoms associated with Parkinson’s disease such as:

  • tremor
  • stiffness and rigidity
  • slowed movement
  • walking problems
  • muscle spasms

DBS will not cure Parkinson’s disease or other neurological conditions. But it can lessen symptoms and improve overall quality of life.

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Process

How does deep brain stimulation work?

DBS is made up of three parts:

  • a battery-operated pulse generator (neurostimulator) implanted in your chest
  • electrodes implanted in specific movement centers of your brain
  • insulated wires (leads) to carry electric pulses from the generator to the electrodes

In addition to Parkinson’s disease, DBS is often used to treat essential tremor and dystonia. In some cases, it has also been used to treat other neurological or psychiatric conditions, such as multiple sclerosis, Alzheimer’s disease, intractable pain, and persistent severe depression.

DBS and Parkinson’s

How does DBS treat Parkinson’s?

Parkinson’s disease causes irregular electrical signals in parts of the brain that control movement. DBS uses electrical stimulation to modulate these control centers deep to the surface of the brain, improving communication between brain cells.

This helps to reduce symptoms such as tremor, slowness, and stiffness. It doesn’t have much of an effect on non-motor symptoms or balance issues. Here are some additional tips for improving motor skills with Parkinson’s.

DBS is the most commonly performed surgical procedure for symptoms of Parkinson’s disease.

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Candidate

Who’s a good candidate for DBS?

DBS isn’t a first-line therapy. It’s intended for people whose symptoms are still unmanageable even with medication. Learn about other advanced and future treatments for Parkinson’s.

You might be a good candidate for DBS if:

  • you’ve had symptoms for at least five years
  • your symptoms respond to medication, but the effect doesn’t last as long as it used to
  • you’ve tried various doses and combinations of medications
  • your symptoms interfere with everyday life

Your doctor is unlikely to recommend DBS if:

  • Parkinson’s medications haven’t helped much
  • you have memory and thinking problems
  • you have anxiety or depression that hasn’t stabilized with treatment
  • you have dementia
  • you’re at high risk of surgical complications

Procedure

What happens during the procedure?

In the operating room, your scalp will be injected with numbing medication. Your head will be placed in a frame to keep it from moving. Small holes will be drilled into your scalp to allow the implantation of electrodes.

You’ll be awake during surgery so you can respond to questions and move particular areas of your body when prompted. This, along with imaging tests, helps pinpoint the areas of the brain where symptoms originate. This is where electrodes will be placed.

Electrodes may be implanted on one or both sides of your brain. The neurostimulator will be implanted under the skin near your collarbone or lower in your chest. Leads will go underneath your skin from head to shoulder, connecting the electrodes to the neurostimulator. The tiny holes in your skull will be closed.

After surgery, you’ll be monitored for complications. You’ll spend at least 24 hours in the hospital, but longer if you have complications.

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Risks

What are the risks and potential complications?

Some risks of surgery are:

  • bad reaction to anesthesia
  • allergic reaction to materials in the implanted device
  • pain or swelling at the surgical site
  • infection
  • stroke
  • movement of the electrodes or hardware breakdown

Potential postsurgical side effects may include:

  • tingling or shocking sensation
  • speech or vision problems
  • dizziness
  • coordination issues
  • trouble with memory or concentration
  • slight paralysis

Other preexisting conditions may increase these risks.

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Efficacy

What kind of results can you expect after having DBS?

A few weeks after the surgery, a specialist will program the DBS settings to your symptoms.

DBS won’t eliminate symptoms, but more than 70 percent of people with Parkinson’s experience a significant improvement.

You’ll likely be able to cut back on medication. DBS settings can be adjusted without surgery. It may take a few months to find the best combination of medications and DBS settings.

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Treatments

Are there any alternative treatments?

Some research suggests that a supplement called coenzyme Q10 may help in the early stages of Parkinson’s when taken for 16 months or longer. For mild to moderate Parkinson’s, the practice of tai chi may help improve balance more than resistance training or stretching.

Other complementary therapies may include:

  • massage or meditation for relaxation
  • acupuncture for pain reduction
  • yoga to improve flexibility and balance

Some dietary or herbal supplements can react with medications, so talk to your doctor before starting any supplements.

After DBS

Life after DBS

The neurostimulator runs on batteries that last three to five years. They can be replaced in an outpatient procedure.

Your doctor will provide you with specific instructions on life with DBS, such as:

  • Identification: Carry your DBS ID card with you and consider getting a medical ID bracelet.
  • At the airport: Your neurostimulator contains a magnet and metal, which can set off airport scanners. Handheld detector wands can affect the functioning and programming of your neurostimulator and shouldn’t be held over it for more than a few seconds. Be sure to inform screeners about the implant and present your ID.
  • Medical procedures: Always tell doctors, medical technicians, and surgeons about your implants. You may not be able to have certain tests, such as an MRI. Avoid using heat on your muscles as physical therapy.
  • Protect your chest: See your doctor if you bump or take a blow to the chest near the device, which could affect its functioning.
  • Deactivation magnet: Your doctor will give you a magnet so you can turn the device off and back on under certain conditions. Keep the magnet at least one foot away from credit cards, televisions, and computer discs to avoid damage to those items.
  • Other screening devices and theft detectors in stores and other public venues can cause your neurostimulator to turn off or on. This may cause a mild, uncomfortable sensation. Show your ID card and ask for assistance in bypassing these devices, if possible.
  • Places to avoid include those with large magnetic fields, such as power generators and automobile junkyards. You should also avoid high-voltage or radar machinery, including television and radio transmitters, high-tension wires, electric arc welders, radar installations, and smelting furnaces.
  • It’s safe to use cellphones, home appliances, and computers, as they won’t cause interference. 
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Outlook

Outlook

DBS won’t slow progression of Parkinson’s disease or prevent you from developing new symptoms. But it can ease the symptoms you’re currently experiencing.

DBS doesn’t make major permanent changes to the brain. The pulse generator can be surgically removed at any time. Talk to your doctor to see if you’re a good candidate for DBS. Find support and information about Parkinson’s online with these inspiring blogs.

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