What is deep brain stimulation?
David Pootrakul, MD, is a neurosurgeon at Banner Boswell Medical Center.
Question: My husband has Parkinson's disease and his medications are no longer working. His neurologist recommends deep brain stimulation to help relieve the tremors. What is it and what does it mean?
Answer: Deep brain stimulation (DBS) is a neurological surgical procedure to treat Parkinson’s disease and other movement disorders that may be explored only when all conceivable medication options have been exhausted.
Neurologists use medications to treat patients who suffer the symptoms of Parkinson’s disease like tremor, stiffness and shuffling gait. The period when medication resolves the symptoms is known as the “honeymoon phase.” However, after about three to five years, many patients no longer respond to the medication and their symptoms return. The treating neurologist then institutes new medication regimens in hopes of recapturing the “honeymoon phase.” Sometimes, new medication approaches fail leaving patients unable to function. This point when the improvement patients first experienced with medication can no longer be found is referred to as “lost paradise.” And, when treatment via medication is ineffective, DBS would be the last option to improve the patient’s quality of life.
As with treatments for many diseases and disorders, medication regimens for Parkinson’s disease have varying side effects like nausea, low blood pressure and dyskinesia, which is characterized by involuntary and often jerky movements of the arms, legs and head. When the side effects and ineffectiveness of medication outweigh the benefits, surgery may be the only viable option for patients with advanced stages of Parkinson’s disease.
DBS entails implanting a small electrode with four contacts into a specific part of the brain known as the subthalamic nucleus. The contacts are hooked up to a neurogenerator (like a pacemaker for the brain). When turned on, the neurogenerator uses high frequencies to stimulate a very specific part of the brain to treat the disease. The procedure is performed with stereotactic frame image-guidance and is completely computerized to ensure absolute precision.
Once the leads and neurogenerator are implanted, the patient returns to his or her neurologist to have the device programmed and medications adjusted. The majority of patients have their medications reduced by more than half. Those patients who must continue to take medication do so without side effects, including dyskinesia.
Due to the risks associated with the procedure, candidates for DBS must have exhausted all medication options to ensure there aren’t any other less risky options available. In addition, they must be free of mental issues including Alzheimer’s disease and dementia, and be deemed medically healthy to be cleared for surgery.
Along with Parkinson’s disease, DBS is being used to treat other neurological disorders and certain psychiatric diseases like obsessive compulsive disorder and major depression. Experiments are even being conducted for possible use down the road in treating obesity.
There are significant risks with DBS, which is why it is considered a last resort for treatment. Risks can include infection and localized stroke; recent studies show that about three percent of patients experience hemorrhage in the brain.
Talk to your neurologist. If all of your medication options have been explored and you’re left with no other alternatives, DBS might be right for you.
DBS is offered at Banner Boswell Medical Center in Sun City.