Deep Brain Stimulation to Treat Parkinson's Disease and Movement Disorders

 

What Is Deep Brain Stimulation?

DBS involves brain surgery to place one or more electrodes in the brain. An extension connects the leads to a battery-operated device called a neurostimulator. The neurostimulator is like a heart pacemaker, but for the brain. It is implanted in the patient's upper chest.

Once the neurologist programs the neurostimulator, it delivers small amounts of stimulation to the brain to help control abnormal brain activity. The amount of stimulation can be controlled and adjusted to manage the symptoms of Parkinson's disease, essential tremor and dystonia that do not improve with medications. Some symptoms may not improve with DBS.

DBS is an effective treatment for many patients, but it only treats the symptoms of the disease, not the disease itself. It is not a cure and does not stop the disease progression. DBS can improve such symptoms as:

• Tremor (shaking)
• Slowed movements (bradykinesia)
• Stiffness (rigidity)

How DBS Works

DBS involves implanting a thin wire, or lead, containing one or more electrodes, in the brain. The lead extends through a small opening in the skull and connects to a neurostimulator — a device that is similar to a heart pacemaker, only for the brain. The surgeon then implants the battery-operated neurostimulator under the skin in your upper chest.

After programming, the neurostimulator delivers controlled and adjustable levels of electrical signals to the brain to soothe symptoms of Parkinson’s disease, tremor and dystonia that fail to improve with medications.

Candidates for Deep Brain Stimulation

The Parkinson’s and Movement Disorders team meets weekly to review patient cases, including patients who may be candidates for the deep brain stimulation procedure. Patient selection is based on a thorough analysis of their medical situation and needs, as well as the best evidence available in medical 

literature and our extensive experience in performing DBS procedures.

Patients who have symptoms for at least 3 – 4 years.
Patients with Parkinson's disease, essential tremor and dystonia who experience movement-related symptoms that cannot be controlled by medications or experience side effects from those medications
Patients who show no significant problems with thinking and memory

New uses for DBS are being investigated, including symptom control for patients with epilepsy, Tourette’s syndrome, depression and chronic pain syndromes.

DBS has been successful in treating patients as young as 13 years old. In general, surgery is performed on patients under 75 years old, but this is not a firm guideline. Each patient must be assessed individually in regard to his or her stamina and overall health.

Thanks to significant innovation in DBS therapy, we offer three FDA-approved DBS devices. You and your movement disorder neurologist will thoroughly discuss the differences between the three options and determine which one meets your needs.

When to Consider DBS

There is a window of opportunity when DBS is an effective treatment, typically in the eight to 12-year range. If you wait beyond the window, symptoms may be too severe to respond.

For essential tremor and dystonia, DBS should be considered after symptoms have failed to improve with one or more medications and the tremor interferes with daily activities.
For Parkinson's disease, DBS should be considered if you've had symptoms for at least four years and your symptoms still respond to carbidopa-levodopa, but the medication causes significant fluctuations or side effects (wearing off, dyskinesias, freezing, dystonia).

If you qualify for DBS, you make a commitment to the process since the workup for DBS and the procedure requires several visits to the clinic and hospital. It is important to determine on medical and personal levels if DBS is right for you.

The screening and evaluation process includes multiple steps.

Consultation where we take a complete medical history and perform a neurological exam 

Videotaped off-on testing where your motor symptoms are rated after you are off medication for 12 hours, then medication is taken and you are monitored while you are on medication

Neuropsychological testing that assesses thinking skills, motor, behavioral, language and executive function (Make sure you bring any glasses or hearing aids, as well as a friend or family member.)
DBS Case Conference with the Movement Disorders team to determine if you are a good candidate.

If you are a good candidate, you will be referred to a neurosurgeon and team to develop a procedure plan.

visit : neurology.pencis.com

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