Deep Brain Stimulation for Parkinson’s Disease: Is It Right for You?
If medication is failing to adequately control your PD movement symptoms, you may be wondering if DBS surgery can help. Get the facts.
For the thousands of people who have Parkinson's disease (PD), carbidopa-levodopa medication is the answer because there is no cure.
But when medication isn't working as well as it used to, deep brain stimulation (DBS) surgery can help reduce or eliminate movement-related problems such as tremor. DBS also offers relief to people with essential tremor and dystonia.
DBS involves placing a small, spaghetti-sized wire deep into the structures of the brain and connecting it to a pacemakerlike device in the chest. This pacemaker allows small electrical pulses to stimulate the brain and, in turn, improve the symptoms of PD. The surgery is usually reversible, can be done on both sides and can be fine-tuned to each patient's needs.
How DBS can help Parkinson's
DBS helps smooth the effect of the medications so you have less "off time" and fewer peak-dose dyskinesias, or involuntary muscle movements. DBS won't make you any better than the medications do, but it will give you more hours of the day in which your medications work well.
After DBS surgery, some patients find that they can reduce the amount of medication they are taking — sometimes by as much as 50 percent.
The ideal DBS candidate has a diagnosis of PD, symptoms not controlled by medication (such as tremor), no dementia and no significant untreated depression.
It might be time to consider it when you're starting to have issues with your medications and you're having a lot of dyskinesias and wearing-off times.
It's also better to have DBS surgery when you're younger. The older you are, the higher the risk of complications.
Selecting the type of DBS surgery
There are two types of DBS surgery.
Awake DBS (traditional): Awake DBS uses a metal frame that is secured to your head. This keeps your head steady and allows us to accurately identify the structure of your brain. You then have an MRI or CT scan so we can see the frame in relation to the brain. We then plug the coordinates of the frame into our sophisticated GPS system. After we place a microelectrode into the spot we want the DBS electrode to go, we can listen to the cells in your brain to make sure that we're in the right place. Once we confirm this, we will replace the microelectrode with the DBS electrode. We then test the electrode to make sure it relieves your symptoms without side effects. Then you get a CAT scan to make sure the DBS electrode is in place. There should be no pain during this surgery. Numbing medicine is used. You are awake but sometimes a little sleepy. Your family can even be present during frame placement if you like.
Asleep DBS: At the University of Michigan, we can now do DBS in an MRI scanner. The computer software in the MRI shows us our target. Then in real time, we can watch the electrode being placed in the MRI to make sure it's going to the right place. The rest of the procedure is pretty much the same as awake brain surgery.
When it comes to choosing between the two, it's really your preference. Some people are anxious about having surgery while being awake. Some patients cannot tolerate being off of their Parkinson's medications for the awake surgery. And some patients feel strongly about being awake for the procedure.
Before choosing either type, the big question to ask yourself is if your symptoms are interfering with your quality of life. You owe it to yourself to ask that question, to answer it honestly and to be as well informed as possible when you decide. Don't be afraid to ask questions of your neurologist, surgeon and health care team.
Choosing a surgery center
When selecting a place for DBS care, look for a medical institution that has a multidisciplinary DBS team, which includes:
A DBS neurosurgeon who has specialized extra training in the placement of the DBS electrode
A DBS neurologist who has specialized extra training in the programming of the DBS system
A DBS neuropsychologist who can evaluate you for early signs of depression or dementia so your health care team can know that ahead of time and not make those conditions worse
A DBS nurse coordinator or programmer who can help get you through the process of several appointments and the surgery
Other DBS team members may include a speech pathologist, a psychiatrist, a nutritionist and a social worker to help with managing some of the issues that can come up at the time of surgery
Programming your DBS electrode is just as important as getting the surgery. This is scheduled for two to four weeks after your surgery to allow for healing.
For more information, make an appointment with the U-M PD team or view Dr. Levin's full presentation on DBS for Parkinson's disease from the 2016 University of Michigan Parkinson's Disease & You Symposium in the video below.
This article is from the Health Lab digital publication.
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