Parkinson's Disease: Deep Brain Stimulation

Tuesday, April 09, 2013 10:50 AM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Aikaterini Markopoulou, MD

What is DBS?
Deep brain stimulation is a type of surgical treatment for Parkinson’s disease. It involves the insertion of electrodes into specific areas of the brain that control movement. The electrodes are connected to a battery that is placed under the skin in the upper part of the chest. Electrical current that passes through the electrode stimulates these brain areas on one side of the brain. This stimulation results in improvement of tremor and slowness or stiffness on the other side of the body.

Who is a good candidate for DBS?
To be a candidate for DBS surgery a number of conditions have to be met:

  • A diagnosis of typical Parkinson’s disease that involves a combination of symptoms such as tremor, stiffness, slowness of movement or balance problems
  • Duration of disease symptoms for more than five years
  • Symptoms that respond well to treatment with levodopa
  • Presence of complications of levodopa therapy
  • Absence of dementia
  • No other diseases or conditions that significantly affect overall health (e.g., conditions that affect blood clotting, heart and lung disease, moderate to severe depression, pregnancy)

Is DBS covered by Medicare?
Yes, DBS is covered by Medicare.

When a patient has bilateral DBS is it necessary to have two stimulators, or will one suffice?
In the majority of Parkinson’s cases, symptoms affect both sides of the body; therefore, electrodes are inserted in both sides of the brain. In some cases where the symptoms affect mostly one side, the electrode can be inserted only in the opposite site of the brain.

If you have DBS, how does it affect your ability to get through airport checks, metal detectors, etc.?
Each patient is provided with an identification card that includes information about the implanted stimulator. The TSA agent should offer a private screening or screening with a manual wand instead of the patient walking through a metal detector.

What percentage of DBS surgeries result in complications? What complications might a patient encounter?
The DBS surgery may result in complications both during the implantation and after surgery, which include bleeding at the electrode insertion site that can be fatal, hardware malfunctioning, and infection and symptom worsening. In a large multicenter clinical trial, 7.5% of patients developed intracranial hemorrhage, 10.6% device-related infection and 8.1% one-sided weakness.

How long is DBS effective?
Studies that have followed patients for ten years have been published and the DBS remained effective throughout the ten-year interval.

Are there any long term risks associated with DBS?
DBS therapy remains a safe treatment option for Parkinson’s patients for at least ten years.

 

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

Tuesday, April 03, 2012 8:57 AM comments (0)

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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