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Deep Brain Stimulation

It is estimated that 6.3 million people have Parkinson’s disease worldwide, affecting all races and cultures. If you are one of them, you probably know this neurological movement disorder is neurodegenerative and currently has no cure-treatments and therefore focused on reducing the symptoms. Deep Brain Stimulation therapy (DBS) was developed more than 25 years ago by Prof. Benabid and Prof. Pollack in France. This is a treatment that has been proven to reduce some of the symptoms associated with Parkinson’s. 

What is DBS therapy?

DBS Therapy is a treatment for the movement symptoms of Parkinson’s including shaking, stiffness, or difficulty moving.

Just like a pacemaker in the chest or abdomen for the heart, a small neurostimulator is surgically placed under the skin in the chest to deliver DBS therapy. The device sends electrical pulses through the extension cables to the leads and electrodes that are placed in an area of the brain that controls movement. These pulses disrupt some of the brain’s messages that cause the symptoms associated with Parkinson’s. DBS therapy is reversible and can be discontinued at any time by turning off the neurostimulator or surgically removing the device.

Benefits of DBS

DBS Therapy extends the control of movement symptoms that your medication already provides. Here you can find out about the benefits of DBS therapy and safety considerations.

It’s very important to mention that the success of DBS depends on:

  • Good candidate selection. This is essential as DBS therapy is not for everybody.
  • Good surgical placement of the DBS electrodes.

By now DBS is a standardized procedure performed in more than 1,200 hospitals around the world. DBS therapy has helped more than 135,000 people continue working, care for their families, return to favourite activities, and experience the joy of doing the simplest things in life again.

Why should you choose DBS therapy?

Seven out of ten people with parkinson’s are eligible for DBS therapy may need an MRI following their implant:

What is MRI?

- MRI is short for Magnetic Resonance Imaging and is a non-invasive way to examine organs, tissues and the skeletal system.

- MRI is used to diagnose causes of common medical conditions of the heart, brain and spine. It produces high-resolution images that help diagnose a variety of problems.

- Compared to CT (X-ray), MRI is safer, provides your doctor with a much better chance of the correct diagnosis. It is now the preferred mode of diagnostic imaging for many disease states, both in terms of guidelines and clinical practice.

Optimized for individual patients

Following  the DBS implant procedure, the doctor will adjust the settings to optimize the therapy based on your individual symptoms. Over time, the settings may be adjusted as your symptoms progress. 

What is the best time to consider DBS therapy?

Parkinson’s is a progressive disease. The symptoms worsen over time. It’s best to consider DBS Therapy before your Parkinson’s symptoms have progressed beyond what is called “the window of opportunity.” This is when your Parkinson’s medications are not as effective as they used to be, but before your symptoms stop responding to medication.
DBS Therapy will be most effective in treating your Parkinson’s if you:

  • Have responded well to the dopaminergic medication (e.g. levodopa)
  • Still benefit from medication, but it’s becoming less effective or causing intolerable side effects
  • Require multiple medications, higher dosages, or more frequent doses to manage your symptoms

The best time to consider DBS therapy is when the side effects of medication have a negative impact on quality of life:

  • Oral medications are controlling symptoms: Start thinking about DBS
  • Oral medications are still working but not so as effectively: DBS may be a good option
  • Symptoms no longer respond to oral therapies: DBS is no longer an option

Understanding the DBS procedure

Learn more about what is involved in the DBS therapy surgical procedure with the summary that follows. Remember, the duration and procedural steps can vary from doctor to doctor.
In general, you can expect the surgery to last several hours. You will spend several days in the hospital for:

  • A pre-operative assessment
  • Healing
  • The surgery
  • Programming

Your DBS surgical team may include a movement disorders specialist, neurologist, neurosurgeon specialized in DBS therapy, anaesthesiologist, radiologist, and other healthcare professionals such as neuropsychologists, etc.

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Does DBS have a safety profile?

DBS therapy has a well-established, long-term safety profile. 

In general 85-89% of people with parkinson’s have improvements with DBS therapy if people are carefully selected If the lead is correctly placed. 

As with any major surgery, there are some risks associated with the procedure, but these are very low when DBS therapy is performed by an experienced team. 

    FAQ

  • Does DBS prevent a person from using future treatments or cures that may come along?

    No. DBS therapy will not reduce future therapy options. DBS therapy is reversible and the system can be removed.

  • Is DBS just for tremor (shaking)?

    No, DBS also treats stiffness and slow or reduced movement, and may provide some relief from non-motor symptoms such as sleep disturbances.

  • Is DBS something to put off as a last resort?

    Definitely not. The window of opportunity is when a person’s Parkinson’s medication isn’t working as well as it used to but it hasn’t stopped working completely. If a person waits too long, the window will close. DBS therapy will not be able to help as much as it could have, had the patient received the therapy sooner

  • How effective is DBS therapy?

    DBS therapy extends the control you already get from your medication from the movement symptoms of Parkinson’s.

  • How long will it take for the DBS therapy to work after the implant procedure?

    Typically, a DBS system is not activated until a patient has healed from the surgery. Once activated, troubling symptoms may decrease. Optimal results are usually achieved after multiple programming sessions with the doctor or nurse who programmes the device.

  • Will I feel the stimulation?

    Many people with a DBS system will not feel the stimulation at all. Some people may feel a brief tingling sensation when the stimulation is first turned on. If the stimulation changes or becomes uncomfortable, the doctor should be contacted immediately.

  • Can normal daily activities be resumed?

    For the first few weeks after surgery, patients who have received DBS should avoid strenuous activity, arm movements over the shoulder, and excessive stretching of the neck. Each individual should talk with their doctor about gradually trying activities that were difficult before surgery.

  • Will the neurostimulator be visible?

    Depending on a person’s body build, the neurostimulator may be noticeable as a small bulge under the skin. However, the therapy is fully implantable and generally not visible, giving patients greater freedom compared with drug delivery therapies.

  • Is DBS therapy permanent?

    No. DBS therapy is adjustable, so that the stimulation can be changed over time to maintain control over a patient’s symptoms. The system can also be turned off or removed if necessary.

  • Will I be able to have an MRI scan with a DBS system?

    Seven out of ten patients eligible for DBS therapy may need an MRI following their implant. Patients should talk to their doctors if an MRI scan is prescribed.

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