Deep Brain Stimulation (DBS) for Parkinson's disease

Overview
People with Parkinson’s Disease whose motor symptoms are debilitating and cannot be controlled with medications, or whose side effects from medications are severe, may be candidates for Deep Brain Stimulation (DBS). Candidates must have intact cognitive function and also be healthy enough to undergo three to six hours of surgery while awake.

While DBS can relieve motor symptoms of Parkinson’s Disease, it is not a cure for Parkinson’s Disease.

What does it involve?
Your neurologist will perform extensive testing to find out whether you are a good candidate for DBS. The pre-surgical evaluation tests may include magnetic resonance imaging (MRI) scans and computed tomography (CT) scans. Pre-surgical evaluation is very thorough to ensure you will receive the maximum possible benefit from the surgery and avoid disruptions of normal brain function. You and your doctor should decide together whether DBS may be right for you. Do not be afraid to ask questions about any aspect of the surgery or recovery.

DBS involves the implantation of a three-part device to block electrical signals that cause tremors and other motor symptoms of Parkinson’s. DBS is implanted in two different surgeries. The first surgery is usually performed while you are awake, with a local anesthetic to numb your scalp. Your head will be kept perfectly still by a device called a stereotactic frame. Remaining conscious will allow you to answer the surgeon’s questions and help them pinpoint the correct locations for the electrodes. The surgeon will place a fine wire and four small electrodes into your brain, and a small generator device (also called the neurostimulator) will be placed near your collarbone. A thin wire will be inserted under your skin to connect the electrodes with the neurostimulator. The first surgery will take three to six hours. You can expect to stay in the hospital for two to three days after this surgery.

The second surgery will happen about a week later. You will be under general anesthetic for this surgery, which will involve placing a pulse generator device containing batteries on your chest wall. The surgeon will also insert a small wire under your skin connecting the pulse generator and the neurostimulator. You will likely spend less than 24 hours in the hospital after the second surgery. A doctor or nurse will educate you on how to care for your wounds.

You will need to take antibiotics to prevent infection while you are recovering at home from the surgeries. You may feel tired, and the surgical sites may be sore. Avoid even light activity such as sex or cleaning the house for the first two weeks. Do not perform heavier activities such as exercise or most types of work for four to six weeks after surgery.

After a few weeks, you will visit your neurologist’s office to program and activate your DBS system. The neurologist controls the amount and frequency of stimulation, and you can turn the device on and off with a magnetic remote control.

You will need to stay in close communication with your neurologist to ensure that your DBS is functioning optimally. The battery for your DBS should last three to five years.

Depending in your condition, you may need to continue taking medication for your Parkinson’s symptoms. You should never suddenly stop taking a medication. Always consult your neurologist for a plan to taper off gradually to avoid withdrawal.

Intended Outcomes
DBS may reduce motor symptoms associated with Parkinson’s, and may allow you to reduce or eliminate some of your medications.

Results
More than 70 percent of people with Parkinson’s Disease who receive DBS experience significant improvements in their motor symptoms.

Constraints
It may take as long as six months of adjusting your DBS settings before you experience benefits from the surgery. DBS surgery may not be successful in controlling your motor symptoms.

Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery. Rarely, DBS surgery can cause seizures.

If the implanted DBS devices become infected, they may need to be removed surgically.

In rare cases, DBS surgery may cause weakness, confusion, or trouble speaking. These changes are usually temporary, but may be permanent.

Your DBS device may be turned on or off by some security screening systems, such as those used in retail stores and airports. If this happens, you might experience an uncomfortable sensation or a sudden worsening of motor symptoms.

The magnet used to turn your DBS device on and off must be kept at least one foot away from televisions and credit cards to avoid damaging these items. Other electronics such as cell phones, appliances, and computers should not be affected by your DBS device.

Contact your doctor immediately if you experience severe headaches, fever or chills, blindness, vision changes, or pain, redness, or swelling at your incision sites.