What Are The Risks
As with any surgery, there are risks associated with deep brain stimulation. If you have DBS, you have about a 3% risk of seizure, infection and confusion. Parkinson’s disease deep brain stimulation also carries a small chance of stroke. Once the neurotransmitter device is turned on, you may experience side-effects such as numbness, muscle tightness, tingling sensations balance problems or mood changes these can be managed with help from your doctor.
Your doctor will work with you to assess your Parkinsons disease and surgery eligibility and discuss the advantages and disadvantages of this treatment route. If you have any questions, do not hesitate to run them past your treatment provider or call the National Parkinsons Foundation helpline on 1-800-4PD-INFO for more information.
APA ReferenceSmith, E. . How Effective is Brain Surgery for Parkinsons Disease?, HealthyPlace. Retrieved on 2022, December 6 from https://www.healthyplace.com/parkinsons-disease/treatment/how-effective-is-brain-surgery-for-parkinsons-disease
What Happens Before Deep Brain Stimulation
Before this procedure, your healthcare provider will discuss the advantages and disadvantages of having a DBS device implanted. Theyll also explain the possible risks that come with this surgery. Theyll also verify that you can have this surgery, which can involve other imaging scans or lab tests to look for any reasons you may not be able to have the procedure.
If you still decide you want to have the DBS implanted, your provider will then have you get detailed magnetic resonance imaging and computed tomography scans of your brain. These scans will help your provider decide which location is the best place to place the wires for the DBS.
Before the procedure, your provider will also talk to you about the following:
Resources For More Information
- Surgical option a potential life-changer for patients with OCD: Read and watch Erins story as she, a lively 21-year-old woman, fought her battle with OCD. This article explores how deep brain stimulation gave Erin her life back. The procedure was the first of its kind performed at Albany Medical Center the only facility offering this treatment between New York and Boston. In Erins own words, “Now, I can be who I really am and tell people my story and hopefully inspire people and help people along the way.
- Karen and Jims Story: A Shared Journey of Life, Love and DBS: Read about Karen and Jim. They were each diagnosed with Parkinsons before they met. Follow them on their journey as they fall in love after meeting each other from an online support group. See how they embraced each other and DBS.
- Kays Story A Parkinsons Disease Patient: Read about Kay, a 68-year-old woman suffering from Parkinsons disease. The article and video explore how DBS helped her regain her life. In Kays own words, Its like I had been turned on again. It was like a miracle.
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Effectiveness Of Dbs In Advanced Versus Early Pd
The efficacy of DBS in advanced PD is widely reported and assessed using MDS-UPDRS IIV. Stimulation of different targets provides different improvements in symptoms however, most improve motor symptoms and activities of daily living in advanced PD. A meta-analysis of 13 randomized controlled trials found significant improvement in PD symptoms after DBS. However, GPi DBS and STN DBS resulted in similar improvement in motor scores or ADL at 36 months. STN DBS significantly reduced medication use as compared to GPi DBS . GPi DBS, on the other hand, significantly improved Beck Depression Inventory scores as compared to STN DBS .
However, recently efficacy of DBS in early PD is showing promising results. A meta-analysis of eight RCTs , of which two recruited early PD patients showed that the UPDRS, Parkinsons disease questionnaire -39, and LED scores improved significantly with DBS as compared to BMT .4 Patients with early PD had a significantly greater reduction of LED than those with advanced PD . No other differences were found in efficacy outcomes between early and advanced PD.4
A very recent prospective randomized trial in early PD patients followed for 5-years showed that STN DBS given along with ODT significantly reduced LED , polypharmacy and disease progression compared to only on ODT.63 Patients on DBS + ODT had a safety profile similar to patients on only ODT.
However, despite its various benefits, currently, conventionally DBS is not used in early PD.
Minimizing Dbs Side Effects For Improved Efficacy
Efficacy of DBS will be higher if the safety profile is manageable and the procedure is acceptable to the patients. Since it is a surgical procedure, usual surgery associated complications such as hemorrhage, infection, and skin erosion are seen.64 Other than these, hardware-related complications such as electrode fracture and stimulator failure have been reported.65
However, the most annoying, common and important postoperative complication of DBS is the side effects caused by electrical stimulation of the surrounding brain tissue these are largely driven by the DBS target and anatomy and functionality of the surrounding brain tissue.66 However, these side effects are easily manageable in most cases.66 Emerging technologies such as segmented electrodes and CL-DBS aim to minimize these side effects.9
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How Deep Brain Stimulation Works
Exactly how DBS works is not completely understood, but many experts believe it regulates abnormal electrical signaling patterns in the brain. To control normal movement and other functions, brain cells communicate with each other using electrical signals. In Parkinson’s disease, these signals become irregular and uncoordinated, which leads to motor symptoms. DBS may interrupt the irregular signaling patterns so cells can communicate more smoothly and symptoms lessen.
Deep Brain Stimulation For Parkinson’s Disease Treatment
Though the exact cause of Parkinsons disease has not been identified, treatment discoveries have been progressive. There is no known cure for the disease, so treatments seek to manage symptoms rather than prevent or slow the progression of the disease. Treatments can vary from drugs, surgeries, behavioral therapy, or a combination of different treatments.
There are three major surgical treatments for PD: ablative surgery, deep brain stimulation , and grafting fetal mesencephalic cells into the striatum.
Despite optimal medical therapy, many patients with moderate to advanced disease have a poor quality of life because of fluctuating response, troublesome dyskinesia or levodopa-unresponsive symptoms.
The chief advantage of DBS is that the stimulation parameters can be customized to the needs of the patient in order to optimize the benefits. Thalamic DBS is most frequently used to control high-amplitude tremor in patients with essential tremor.
The subthalamic nucleus or globus pallidus interna are the most frequent targets for DBS treatment of patients with PD with disabling tremor and/or levodopa-related motor complications.
While DBS is a proven effective therapeutic strategy, its success depends on the appropriate selection of patients and the experience and skill of the stereotactic surgeon in order to optimize the results and minimize complications.
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What Is The Dbs Surgery Process
Patients suitable for this surgery will be brought to the hospital and taken through the necessary preoperative evaluations. They will undergo DBS surgery on the second day, where the actual brain surgery part of the intervention is. The patients are awake, able to talk with us and communicate their experiences during the surgery.
During this approximate 2.5-hour process, the medical team creates the physiological map of the brain using the Microelectrode Recording and Stimulation technique and by establishing cooperation with the patient. The surgeon places DBS electrodes by locating the brain cells responsible for the disease with an error margin of fewer than 80 microns.
Afterward, within half an hour, when the patient is anesthetized, the surgeon places the neurostimulator in the chest area and connects it to the DSB electrodes with extension cables. After the operation, the treating doctor provides neurostimulator programming, reduces and adjusts the patients medications within 2-3 weeks of outpatient clinic control.
Will I Have To Limit My Activity Following Deep Brain Stimulation Surgery
- You should not engage in light activities for 2 weeks after surgery. This includes housework and sexual activity.
- You should not engage in heavy activities for 4 to 6 weeks after surgery. This includes jogging, swimming, or any physical education classes. Anything strenuous should be avoided to allow your surgical wound to heal properly. If you have any questions about activities, call your doctor before performing them.
- You should not lift more than 5 lbs. for at least 2 weeks.
- You should not raise your arms above your shoulders or over bend or stretch your neck.
- Depending on the type of work you do, you may return to work within 4 to 6 weeks.
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What Is The Recovery Time
Your healthcare provider is the best person to tell you what to expect regarding your recovery time and when you will notice changes in your symptoms and how you feel. They can tell you the likely recovery time youll need, which can vary depending on other factors like your overall health, other conditions you have and your personal circumstances.
Most people will need to stay in the hospital for one day after surgery to implant the DBS leads in their brain. Surgery to implant the pulse generator is usually a procedure where you go home the same day.
Overall, recovery time generally takes several weeks. Your healthcare provider will likely have you do the following:
- Avoid any kind of activity for about two weeks after each procedure: This includes things as minor as household chores or sexual activity. You should not lift anything heavier than 5 pounds .
- Avoid moderate- or high-intensity activity for at least four to six weeks: This includes exercise and physical labor. Most people can return to work or their usual routine after this.
- Use caution when moving or stretching: You should avoid making certain movements, like raising your hands over your head, for several days after surgery to implant the pulse generator. Your healthcare provider will tell you how long youll need to restrict your movements.
How should I care for the surgical area once Im home?
What Is Deep Brain Stimulation Or Dbs
Deep brain stimulation, or DBS, is often described as a pacemaker for the brain. It works much like a pacemaker, sending electrical signals to the brain instead of the heart. DBS is primarily utilized for patients who have Parkinsons disease, dystonia, or essential tremor, and who cant adequately control their disease with medication. Before any patient is considered for the surgery, they are evaluated by the U-M interdisciplinary team. That team includes a neurosurgeon, neurologist, clinical neuropsychologist, speech pathologist, social worker, and other team members who ensure that you and your family understand the procedure and discuss your expectations and concerns.
Its important to understand that DBS does not offer a cure for your disease, but a way to manage it more effectively. It can offer many benefits, including the need to take less medication and therefore experience fewer medication side effects.
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Comparing Stn Dbs With Gpi Dbs
Sustained benefits of DBS of STN and GPi have been reported on motor function, motor fluctuations, dyskinesia and QoL. Several studies have shown that STN DBS can reduce levodopa equivalent daily dose by 48% to > 50%, 1 to 4 years post-surgery31,32 STN DBS is more effective in reducing LED than GPi DBS.33,34 Thomsen et al showed a reduction in medication use by 55% and 44% after 1 year and 8 to 15 years, respectively of STN DBS.8
Though both targets reduce levodopa induced dyskinesia , GPi DBS is more effective in reducing LID than STN DBS .35 Post DBS increase in levodopa dose results in higher rates of dyskinesia with STN DBS than GPi DBS.27,
The overall side effect profile of both targets is similar, but speech related adverse effects, dysphagia and gait disturbances are more common in STN DBS than GPi DBS.
As seen in this comparative review section, both STN DBS and GPi DBS are efficacious and safe targets in PD. Both STN DBS and GPi DBS have similar benefits, but a particular benefit may be more pronounced by targeting one of them. Hence, it is difficult to conclude which is a better target for DBS. Therefore, the choice between these two targets should be carefully based on the outcome desired.
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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Introduction To Parkinson’s Disease
Prepare Parkinson’s disease Parkinson’s disease is the second most common chronic neurodegenerative disease after Alzheimer’s disease the first, with a high incidence and is seen in 1-3% of all people over 65 years of age. Men are affected 1.5 times more frequently than women.
Research studies have linked theories regarding the outbreak of PD to both environmental and genetic circumstances. These theories propose associations between PD and chemical reactions, neurotoxins, and genetic susceptibility or predisposition.
The main cause of PD is the loss of nigrostriatal dopaminergic neurons, disruption of dopamine and acetylcholine balance in the basal ganglia is also effective in the development of the disease.
The main and early symptoms of PD include bradykinesia /akinesia, rigidity, rest tremor later findings are postural instability and walking and balance disorders and it is a progressive movement disorder.
It is considered Diagnosis in Parkinson’s disease The diagnosis of PD is clinical and can be made using the UK Parkinsons Disease Society Brain Bank Criteria. The core clinical features of PD are bradykinesia and a combination of muscular rigidity, tremor and/or postural instability not explained by visual, cerebellar, proprioceptive or vestibular failure.
Deep Brain Stimulation Still Effective After 15 Years In People With Parkinson Disease Study Shows
Deep brain stimulation of the subthalamic nucleus was shown to remain effective in treating motor complications of people with Parkinson disease 15 years after initial surgery.
Deep brain stimulation of the subthalamic nucleus may prove effective after more than 15 years in patients with Parkinson disease , according to study findings published last week in Neurology.
Associated with several positive outcomes in patients with PD, including of disease progression, researchers say that STN-DBS has been shown to maintain efficacy in patients up to 11 years after surgery. However, conflicting reports have indicated DBS may lose efficacy over time.
Initial post-operative quality of life improvement has been described to fall to preoperative levels after 5-year stimulation, likely due to the escalation of both levodopa- and stimulation-resistant motor and nonmotor features of PD, such as impairments of gait, balance, speech and cognition, said the study authors.
With a growing rate of PD diagnoses and number of STN-DBS procedures conducted, researchers note that large data examining efficacy after the second and third decades post-procedure is lacking, with small populations having been the focus of previous studies examining motor response from STN-DBS after more than 10 years.
A mean follow-up time of 17.06 ± 2.18 years was reported among the study cohort.
Reference
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Who Is Not A Good Dbs Candidate
You are not a good candidate for DBS if:
- You have Parkinsons plus symptoms or do not have a clear diagnosis of Parkinsons.
- You need full-body MRI scans, or certain head and chest MRI scans.
- You cannot operate the internal pulse generator, also called the stimulator or IPG.
- Test stimulation does not work.
- You have certain brain conditions such as ischemic brain disease, demyelinating brain disease or brain tumors.
- You have significant intellectual or memory impairment.
- You are not healthy enough to have surgery or have other untreated or chronic illnesses.
DBS can work well for certain people. But it can make certain symptoms of Parkinsons worse. People with certain symptoms should not have DBS. These include:
- Having Parkinsons that is not a typical form of the disease.
- Having Parkinsons plus symptoms such as multiple system atrophy, progressive supranuclear palsy or vascular parkinsonism.
- Not functioning well, even with medication for example, not being able to walk even when taking medication.
- Having end-stage Parkinsons.
At OHSU, we are committed to providing the best treatment for everyone with Parkinsons, so our specialists will talk with you about other options if DBS is not right for you.
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.
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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 dont typically improve with present-day DBS. Others are developing a smart DBS device that can record a persons 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 Parkinsons diagnosis to see if the therapy may slow or stop disease progression. Testing in Parkinsons models showed the therapy may help protect brain cells, and a small human trial showed motor symptoms improved after early-stage DBS.