Guest Post: Arif Dalvi, MD, MBA - A Pacemaker for the Brain: DBS and Parkinson’s Disease

Tuesday, April 03, 2012 8:57 AM

In Parkinson’s disease (PD) low levels of dopamine in the brain lead to the symptoms of tremor, slowness, stiffness and difficulty walking. There is an easy way to replace dopamine with Sinemet tablets. The levodopa in these tablets is converted to dopamine in the brain and helps relieve the symptoms. Why then should we consider a surgical treatment for PD?DBS and Parkinson's Disease

Over time, patients on PD show a fluctuating response to medications. A dose that would last four to six hours now lasts for two or three hours. In between doses, the symptoms return with a vengeance. In addition there may be involuntary movements called dyskinesias or a severe tremor not controlled despite increasing doses of medications.

Deep brain stimulation (DBS) surgery is a way out of this predicament. While not a cure, it can set the clock back on the severity of the disease. Some patients can reduce medication doses thereby reducing the side effects. Tremor, dyskinesias and muscle rigidity are symptoms that improve the most. Patients show a longer duration of action of medications following surgery.

The surgery is a three-part process that involves placing an electrode in the brain connected to a pacemaker device placed under the skin in the chest. The first part maps the brain using MRI techniques. To further improve the accuracy of the electrode placement, the NorthShore DBS team uses a sophisticated brain mapping technique called microelectrode recording. The third part involves placing the pacemaker and connecting it to the brain electrode. Patients typically return home in 2-3 days after surgery.

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The NorthShore DBS team has over 15 years of experience with DBS surgery. Dr. Dalvi has been involved with training neurologists nationally on managing the DBS pacemaker settings following surgery. When medications for PD fail it is time to consider DBS surgery.

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