Deep Brain Stimulation (DBS) Surgery

Surgery may be an option to relieve symptoms for some people with Parkinson’s.  International experts in PD gathered in 2011 to collaborate and publish an expert consensus on Deep Brain Stimulation (DBS).  The committee concluded DBS is most effective in younger patients with advanced symptoms who have responded well to Levodopa therapy.    DBS can be performed in two areas of the brain the STN (subthalamic nucleus) and GPi (globus pallidus pars interna).  DBS is effective in controlling tremors and dyskinesia, but may cause more non-motor symptoms in GPi deep brain stimulation.  DBS should be performed by an experienced neurosurgeon with the support of an interdisciplinary team.  Deep brain stimulation is not for everyone, but timing is important.  Ask your neurologist if you are a good candidate for the procedure.

Medtronic

The Right Time for DBS

As you know, the symptoms of Parkinson’s get worse over time. During the course of the disease, there is a period when DBS Therapy can do the most good to help control your symptoms. The right time for DBS is when your body stops responding to medication as well as it used to, but before your medicine stops working completely. If you wait too long, DBS Therapy will not be an option.  So don’t think of DBS as something for later, but as something to explore now.

Signs Levodopa Is Losing Effectiveness

You are probably taking levodopa to control your movement symptoms. Brand names include Parcopa, Sinemet, and Stalevo.*

After 2 to 5 years, many people find that levodopa is becoming less effective at controlling their symptoms. Signs to watch for include:

  • More hours a day with symptoms.
  • Longer waits for relief to kick in after taking a dose.
  • Wearing off of the medication between doses.
  • Needing to take it more often, including at night.
  • Drug-induced side effects like uncontrolled movements.

Time to Talk to Your Doctor

If you are seeing signs that your medication is losing effectiveness, refuse to surrender to Parkinson’s. Don’t just let Parkinson’s take time away from you. Ask your doctor or a specialist now if DBS Therapy may be right for you. Know your options for the road ahead. By not waiting until the last minute, you’ll be prepared to make a decision whenever you need to.

* Sinemet is a registered trademark of Merck and Co., Inc., Stalevo a registered trademark of Novartis Pharmaceuticals Corporation, Parcopa a registered trademark of SRZ Properties, Inc.

What Is DBS Therapy?

Medtronic Deep Brain Stimulation (DBS) Therapy is a surgical treatment proven to reduce some of the symptoms associated with Parkinson’s disease.1   Medtronic DBS Therapy for Parkinson’s control helps reduce some of the symptoms of Parkinson’s disease and is used in conjunction with medication. Electrical stimulation is delivered to targeted areas on both sides of the brain to help relieve symptoms on both sides of the body. You may be a candidate for this therapy if your symptoms respond to levodopa, but levodopa and/or other medications have become less effective or ineffective.

How It Works

DBS uses a surgically implanted medical device, similar to a cardiac pacemaker, to deliver electrical stimulation to precisely targeted areas within the brain.

Stimulation of these areas blocks the signals that cause the disabling motor symptoms of Parkinson’s disease. The electrical stimulation can be noninvasively adjusted to maximize treatment benefits. As a result, many individuals may achieve greater control over their body movements.

DBS System

The DBS system is implanted inside the body and includes three major parts.

The lead is a set of thin wires covered with a protective coating. It carries the therapy signal to the electrodes that deliver stimulation to the brain. Approximately 4 inches of the lead are implanted inside the brain. The rest of the lead (about 15 inches) is implanted under the skin of the scalp.

The extension is a set of thin wires covered with a protective coating that connects the lead to the neurostimulator. The extension is connected to the end of the lead, just behind the ear (or where your doctor decides is the best placement). The connection point between the lead and the extension is placed under the scalp. The remaining length of the extension is placed under the skin down the neck to the upper chest area and connects to the neurostimulator. For each lead, you will have one extension.

The neurostimulator contains the power source of your DBS system. The neurostimulator generates and controls the therapy stimulation. The neurostimulator is implanted just under the skin in the upper chest area.

These electrical pulses are delivered through the extension and lead to the targeted areas in the brain. The pulses can be adjusted wirelessly to check or change the neurostimulator settings.

Additional non-implanted components of the Medtronic DBS System may include: a charging system (for rechargeable devices only) or a patient programmer.

Operating the System

Your clinician programs the system to manage your individual symptoms. In addition, your clinician may provide you with a small, handheld patient programmer. This programmer may allow you to adjust the system and turn it on and off.

References

Medtronic DBS Therapy for Parkinson’s disease and Essential Tremor Clinical Summary, 2009.

Adapted from http://www.medtronic.com/patients/parkinsons-disease/therapy/what-is-it/index.htm and http://www.medtronicdbs.com/parkinsons/about/introduction-to-dbs-therapy/index.htm

Medical Disclaimer

Articles

DBS for PD An Expert Consensus

Understanding DBS

Video

DBS Therapy for Parkinson’s: On and Off