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
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
DBS acts on areas of the brain thought to be overactive during the involuntary movements associated with tardive dyskinesia.
One theory is that the long-term blocking of dopamine receptors can
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
- 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
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
Risks from surgery include:
- brain hemorrhage
- infection in the brain
- bleeding and swelling of brain tissue
- malfunction of the IPG device
- 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
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.