Parkinson's Disease Treatment with Deep Brain Stimulation

June 30, 2014
Parkinson's Disease Treatment with Deep Brain Stimulation

Parkinson's Disease treatment with Deep Brain Stimulation (DBS) has been used for over a decade to help stop uncontrollable shaking.   It is typically offered when medications no longer help.  Similar to all of the presently available Parkinson's drugs, surgical options offer symptomatic benefit. It can ease symptoms but has not been proven to change the underlying course of disease. It is usually done in people who have had Parkinson's for at least four years and still get a benefit from medication but have motor complications, such as significant "off" time (periods when medication isn't working well and symptoms return) and/or dyskinesia (uncontrolled, involuntary movements).

DBS typically works best to lessen motor symptoms like stiffness, slowness and tremor. It doesn't work as well for imbalance, freezing when walking or non-motor symptoms. DBS may even exacerbate thinking or memory problems so it's not recommended for people with dementia.

Deep Brain Stimulation:  How It Works

A surgeon implants a small battery operated device similar to a pacemaker under the skin near the collar bone. The doctor then positions wires from the device with electrodes on their ends in areas of the brain that control motor function. Usually a person remains awake during surgery so that he or she can answer questions and perform certain tasks to make sure that the electrodes are positioned correctly. The device works by electrically stimulating these areas and blocking the abnormal nerve signals that cause the tremor in Parkinson's disease patients.

Most people with Parkinson's disease will require the surgery be done on both sides of the brain.The procedure is performed with the patient awake to ensure optimal placement of the electrodes and maximize the potential for benefit.  A few weeks after surgery, a movement disorder specialist uses a handheld programmer to set parameters, tailored to each individual's unique symptoms, into the neurostimulator. The DBS settings are gradually tweaked over time and medications are simultaneously adjusted. Most people are able to decrease (but not completely discontinue) Parkinson's drugs after DBS. Determining the optimal combination of drugs and DBS settings -- that which gives the most benefit and the least side effects -- can take several months and even up to a year.