Patients And Clinical Data
The patients with PD who had undergone the DBS procedure in our center from January 2011 to December 2018 were retrospectively analyzed. Of note, a DBS procedure was defined as any stereotactic surgery that involved implantation of the new intracranial electrode as well as IPG. A total of 229 DBS procedures of 225 patients were enrolled, and data was cross-checked with the manufacturers records . All DBS operations were performed by two primary surgeons . Follow-up was done at the outpatient service and telephone interview by December 31, 2020. Readmission referred to the unplanned admission to our center for any clinical situation related to DBS procedure after the primary discharge. Appointed readmissions for IPG exchange and contralateral electrode implantation were excluded. Ethical approval was obtained from the Medical Ethical Committee, Qilu Hospital of Shandong University .
Who Should Get Deep Brain Stimulation
This is a common question with a surprisingly simple answer: Anyone who would get significant benefit from the treatment and can undergo the operation with minimal risk. It is not necessary to suffer for years after diagnosis, trying every known combination of medicine, before DBS can be considered. DBS is a surgical option that is known to improve quality of life for patients with movement disorders, so when ones quality of life is dramatically affected by the disease or by medication side effects, its time to consider DBS.
Research To Improve Deep Brain Stimulation
Researchers are working to improve upon existing DBS devices and methods to help treat more symptoms and more people. Some researchers are putting electrodes in a different area of the brain the pedunculopontine nucleus to treat walking and balance problems that don’t typically improve with present-day DBS. Others are developing a “smart” DBS device that can record a person’s unique brain signals and deliver electrical stimulation only when needed, such as when symptoms return, rather than continuously, as the current systems do. This could help reduce side effects such as numbness and weakness and lengthen the battery life of the neurostimulator, which would result in a longer time between battery replacement procedures.
Scientists also are planning to test deep brain stimulation in the first years after a Parkinson’s diagnosis to see if the therapy may slow or stop disease progression. Testing in Parkinson’s models showed the therapy may help protect brain cells, and a small human trial showed motor symptoms improved after early-stage DBS.
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Is Deep Brain Stimulation Effective Against Parkinsons
Jul 12, 2021 | Guides
Although theres no definitive treatment to cure Parkinsons disease, doctors might recommend lifestyle modifications, supportive therapies, or medications based on your symptoms.
Stats show that more than 60,000 US citizens are diagnosed with Parkinsons disease every year. Around 10 million people are currently living with initial or advanced stage PD worldwide. In addition, April is observed as Parkinsons Disease Awareness month in which we strive to create awareness about this unforgiving medical condition.
Among many kinds of preventive or restorative treatments available for Parkinsons, Deep Brain Stimulation is considered one of the most effective ones.
This technique was first approved in 1997 to treat Parkinsons tremors and advancing symptoms. With technological advancements, in 2016, DBS was approved for treating early Parkinsons stages. Our spinal and neurosurgeons prescribe and perform DBS on patients with five years or more history of motor and memory symptoms associated with Parkinsons.
Lets get to know more about deep brain stimulation and its impact on Parkinsons disease patients.
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Surgical Relief For Neurological Disorders
When medication isnt enough to control symptoms of certain neurological disorders, deep brain stimulation can be a viable option for symptom relief. For those who experience tremors, stiffness, slowness and involuntary movements, performance of daily tasks can be difficult or frustrating.
While DBS doesnt provide a cure, it can be used to significantly control symptoms for a number of conditions for many years. For example, DBS is the most commonly performed surgical treatment for Parkinsons disease and can help reduce symptoms such as tremor, stiffness and slowed movement while allowing a reduction in medication. Often, the reduction in medication improves many side effects.
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Surgery To Implant The Deep Brain Stimulation Device
Deep brain stimulation requires the surgical implantation of an electrical device into the brain. A neurosurgeon uses imaging scans to pinpoint the right spot in the brain for implanting the electrode.
When surgeons have determined the correct location, they create a small opening in the skull and insert a thin, insulated wire, through which they insert the electrode. Surgery to implant the electrode takes about four hours and requires general anesthesia. You may then stay overnight in the hospital for observation.
The next day, doctors perform the second part of the surgery, which involves connecting the insulated wire to a battery-operated pulse generator that is implanted under the skin near the collarbone. Most people can return home after this procedure.
Several days after the surgery, you meet with your neurologist, who programs the pulse generator. Pushing a button on an external remote control sends electrical impulses from the pulse generator to the electrode in the brain.
People who use deep brain stimulation work closely with their neurologist to find the combination of settings that best controls their symptoms. After several visits, they are able to control the strength of the electrical impulses on their own. Following this adjustment period, most people require only occasional maintenance visits.
Signs Indicating That Youre A Suitable Candidate For Dbs
Deep brain stimulation isnt suitable for every patient who suffers from Parkinsons disease. Here are the common signs and symptoms that may lead a physician to recommend DBS treatment.
- Parkinsons disease symptoms lingering for five years or more
- You experienceintermittent memory loss issues
- Your symptoms worsen sometimes despite regular medical administration
- Youre suffering from dyskinesia
- Medications have adverse side effectson your health
- Parkinsons disease symptoms are affecting your daily routine and activities.
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Awake Vs Asleep Surgery
Standard DBS surgery is performed while you are awake and requires that you stop taking the medicines that control your Parkinson’s symptoms. During surgery, you are asked to perform tasks to help guide the electrode to the precise location in the brain.
Being awake during brain surgery, or being off medicine, is unsettling for some people. Asleep DBS is an alternative option at some centers.
Asleep DBS surgery is performed while you are unconscious and under anesthesia. Surgery takes place in an MRI or CT scanner to target and verify accurate placement of your DBS electrodes. Ask your surgeon if asleep DBS is an option for you.
|Must hold medications the morning of surgery||Don’t have to hold medications|
Who Is A Candidate For Deep Brain Stimulation
DBS is more than just a surgical procedure. It involves a series of evaluations, procedures, and consultations before and after the actual operation, so people interested in being treated with DBS should be prepared to commit time to the process.
For example, those who do not live close to a medical center that offers DBS surgery may need to spend significant time traveling back and forth to appointments.
The procedure, as well as the pre-operative evaluation and post-operative follow-up, can be expensive depending on the persons insurance coverage. DBS surgery is an FDA-approved treatment for Parkinsons disease, and Medicare and most private insurers cover the procedure, but the extent of coverage will depend on each persons individual policy.
Prospective patients should have realistic expectations about DBS results. Although DBS can improve movement symptoms of Parkinsons disease and greatly improve quality of life in properly selected patients, it is not likely to return anyone to perfect health.
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Why The Procedure Is Performed
DBS is commonly done for people with Parkinson disease when the symptoms cannot be controlled by medicines. DBS does not cure Parkinson disease, but can help reduce symptoms such as:
- Temporary pain or swelling at the site where the device was implanted
- Temporary tingling in the face, arms, or legs
- Bleeding in the brain
Problems may also occur if parts of the DBS system break or move. These include:
- Device, lead, or wires break, which can lead to another surgery to replace the broken part
- Battery fails, which would cause the device to stop working properly
- Wire that connects the stimulator to the lead in the brain breaks through the skin
- The part of the device placed in the brain may break off or move to a different place in the brain
- You will trigger alarms when you are scanned at the airport, but the TSA agents are used to this happening
Possible risks of any brain surgery are:
- Blood clot or bleeding in the brain
Risks of general anesthesia are:
- Reactions to medicines
Less Medication More Relief
Medtronic DBS therapy may reduce the need for other Parkinsons medications1 and, consequently, medication-related side effects. DBS delivers therapy 24 hours a day and doesnt wear off while sleeping. Its already working when you wake up.
* Signal may not be present or measurable in all patients. Clinical benefits of brain sensing have not been established.
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What To Expect After Dbs
Surgery to implant the leads generally entails an overnight stay, while the IPG is usually implanted as same-day surgery. During recovery, your surgeon will talk to you about caring for your wounds, when you can shower, and any activity restrictions. Its usually recommended that any heavy lifting be avoided for a few weeks.
After another two to four weeks, youll return to have your device programmed. This process will continue for several weeks to ensure the stimulation settings are optimal to control your symptoms. During these visits, you will be shown how to turn the device on and off with the handheld device and check the battery level.
Once the programming has been completed, you will have regular follow-up visits to check and adjust the stimulation to maintain the most benefit for your symptoms.
Does Insurance Cover Deep Brain Stimulation
Many insurances will cover DBS, especially if it has official approval to treat that condition. Its important that you contact your insurance company to learn if they cover DBS procedures in any way.
A note from Cleveland Clinic
Deep brain stimulation is a treatment option that can help with a wide range of conditions that affect your brain function and mental health. Its almost always an option after other treatments and methods are unsuccessful. Its most common for conditions like Parkinsons disease and epilepsy, but researchers are also exploring the possibility of using it to treat many other conditions. While it does involve two to three surgeries, its also very effective at helping reduce symptoms and treat conditions that severely affect your quality of life.
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Why It Is Done
Deep brain stimulation may be used to relieve symptoms of Parkinsons disease, especially tremor, when they cannot be controlled with medicine. It is considered the surgical treatment of choice for Parkinsons disease, because it is more effective, safer, and less destructive to brain tissue than other surgical methods.
Deep brain stimulation of the thalamus is done to treat both disabling tremor caused by Parkinsons disease and essential tremor.
Procedures that stimulate the subthalamic nucleus and the globus pallidus are done to help control a wider range of symptoms and are used more often than stimulation of the thalamus. Symptoms that are most often helped include problems with changes between on and off time and dyskinesia. Symptoms that are less likely to get better include problems with walking, balance, and speech. In some cases, DBS can make these problems worse.
Deep brain stimulation may also be used to treat severe tremor related to multiple sclerosis . Deep brain stimulation usually is a last resort after all other options have been tried without success to treat MS tremor. Only people with severe tremor are candidates.
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How Does Deep Brain Stimulation For Parkinsons Work
Deep brain stimulation works by modifying abnormal electrical activity in the brain. It was first approved for Parkinsons tremors in 1997 and has become an established treatment to control additional motor symptoms of Parkinsons disease.
DBS involves three main components:
- Leads: Leads are implanted in the brain in a region responsible for motor activity.
- Implantable pulse generator : A separate procedure is performed to implant a battery-operated device in the chest or in the abdomen. An IPG is similar to a pacemaker for the heart and has been coined by some as a pacemaker for the brain.
- Extension: A thin, insulated wire is passed beneath the skin between the leads and implantable pulse generator to deliver the electrical stimulation from the pulse generator to the leads.
The target area in the brain is first identified by magnetic resonance imaging or computed tomography . Then, the leads are placed via small holes that a surgeon drills in the skull.
This is considered a minimally invasive surgery that is done in the operating room with local anesthesia. It usually requires an overnight stay.
The IPG is inserted in a separate surgical procedure in the operating room roughly a week later.
After a few weeks, a neurologist begins to program the unit. This process can take several additional weeks to months. When this is completed, people are able to manage the device with a handheld remote control.
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What You Need To Know
- Surgeons implant one or more small wires in the brain during a surgical procedure.
- The leads receive mild electrical stimulation from a small pulse generator implanted in the chest.
- Proper patient selection, precise placement of the electrodes and adjustment of the pulse generator are essential for successful DBS surgery.
- DBS does not fully resolve the symptoms of PD or other conditions, but it can decrease a patients need for medications and improve quality of life.
Can I Use Electrical And Electronic Devices If I Have Dbs Devices Implanted
In general, electronic devices and appliances shouldnt cause any problems with the pulse generator. If they do, the most likely effect is that your pulse generator will switch off. This might not have an immediate effect, but sometimes youll notice that your symptoms get worse, or you’ll notice an unpleasant feeling or sensation.
In general, you should keep in mind the following:
- Your healthcare provider will give you two key items you should keep nearby whenever possible: an ID card and a patient programmer. The ID card can help you in situations with certain kinds of electronic devices like metal detectors or anti-theft scanners. The patient programmer allows you to turn the device on and off, plus adjust settings for the stimulation if needed.
- Home appliances, such as microwaves, computers, smartphones and other common electronics, shouldnt cause any kind of interference or problems with your pulse generator.
- Having one or more DBS leads and a pulse generator implanted in your body means you can’t have certain medical and diagnostic imaging procedures. The procedures you can’t have are magnetic resonance imaging scans, transcranial magnetic stimulation and diathermy.
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Why A Doctor May Choose Deep Brain Stimulation
According to the National Parkinson Foundation, the ideal Parkinsons disease candidate for DBS surgery has:
PD symptoms that interfere with activities of daily living.
Fluctuations in mobility due to PD medications with or without dyskinesia .
Continued good response to PD medications, even if the medication effects may wear off sooner than they have in the past.
A history of several different combinations of PD medications while under the supervision of a neurologist specializing in movement disorders.
These factors* may make a person a less than ideal candidate for DBS surgery:
Difficulty with balance, walking, or freezing as the main disabling symptom.
A primary symptom of speech difficulty.
Continuous confusion and problems with memory and thinking.
A psychiatric condition such as depression or anxiety that has not improved or stabilized with other treatment.
Another condition that increases the risk for surgery complications.
*Some of these factors may be treatable. Having one or more does not disqualify a person for future DBS surgery, but the doctor may recommend more aggressive therapy focused on these issues before surgery takes place.
Living With A Dbs Device
Batteries most often last three to five years, but this can vary. Rechargeable batteries may last up to 15 years.
There are several precautions related to electrical/magnetic devices that are important, but usually easy to accommodate. Items such as cell phones, computers, and home appliances do not generally interfere with the stimulator. Keep your stimulator identification card handy when you are out and about, in your wallet or purse.
Be aware that some devices may cause your transmitter to turn on or off. This includes security monitors that might be found at the library and retail shops.
If this occurs accidentally, it is not usually serious, but may be uncomfortable or result in your symptoms worsening if the stimulator is turned off. When you visit stores with these devices, you can ask to bypass the device by presenting your stimulator identification card.
Keep the magnet used to activate and deactivate the stimulator at least 12 inches away from televisions, computer disks, and credit cards, as the magnet could potentially damage these items.
Air Travel/Metal Detectors
Talk to TSA personnel when traveling by plane, as the metal in the stimulator may set off the detector. If you are asked to go through additional screening with a detector wand, its important to talk to the person screening you about your stimulator.
Medical Diagnosis and Treatment
Occupational Electromagnetic Concerns
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