Deep Brain Stimulation (DBS) is a surgical treatment for Parkinson’s Disease, essential tremor and dystonia. It has been FDA approved in the US since 1997 and there have been over 85,000 implants performed worldwide for the treatment of movement disorders. DBS can be thought of as a brain pacemaker. The surgery entails placing a small wire in the area of the brain affected. The wire is then passed under the skin down to the chest where the pacemaker is implanted. This brain pacemaker system, continuously delivers an electrical stimulus to the affected regions of the brain. The electrical pulse is small and is not felt by the patient, however it is able to affect the activity of the brain to improve the symptoms of Parkinson’s disease.
What are the benefits of surgery?
For someone considering surgery for Parkinson’s Disease, it is very important to understand how DBS affects the different symptoms of Parkinson’s Disease. DBS is not a cure for Parkinson’s disease. The stimulation can help treat some but not all of the symptoms of the disorder. As a good rule of thumb, DBS works for symptoms that respond to levodopa. DBS is a very good treatment for tremor associated with Parkinson’s Disease, for the rigidity or stiffness, for bradykinesia or slowness, and for dyskinesias which are the uncontrollable movements that are side effects of long term levodopa use. It also is great for minimizing the ON/OFF fluctuations that occur when someone has been taking medication for a long time. ON time is when a person has relatively good mobility and OFF time is when the mobility is lost as the medication effect wears off. Stimulation can smooth out the day and make more of the day as ON time for the patient. DBS does not help problems with speech, problems with balance or problems with cognition such as forgetfulness, decreased decision making abilities and difficulty with language and in fact it may worsen these if they are pre-existing.
When is someone considered a candidate for surgery?
Most patients with Parkinson’s Disease respond well to medication and get relief of their symptoms. Patients are considered for surgery when the symptoms become difficult to manage with medication alone. When someone is taking a lot of levodopa or its equivalent on a daily basis, or have a medication frequency which is difficult to manage, or are having adverse side effects to the medications, they are considered good candidates for surgery. In addition, surgery is a good option when patients develop the uncontrollable movements called dyskinesias or are having multiple ON/OFF fluctuations during the day.
Is there an age limit for surgery?
While most people who undergo deep brain stimulation are under seventy years old, there is no real age limit for the surgery. If the individual is healthy and they are otherwise a good candidate for DBS, then most centers would consider doing the surgery.
Why is surgery needed on both sides of the brain?
In general, one side of the brain controls the opposite side of the body. So DBS on one side of the brain will affect Parkinson’s symptoms on the other side of the body. Patients with symptoms on both sides of their body will get their best relief with surgery on both sides of the brain. DBS leads can be placed on both sides during the same operation. The decision to go ahead with one side versus two, is usually made before the surgery and it depends on the patients symptoms, health and age. Some patients have symptoms that are mostly on one side of the body and these patients may get very good relief with one sided surgery. In patients who may be more elderly or have health issues and need stimulation on both sides, the two sided surgery can be staged with one side done in one operation and the other done several weeks later.
How is the surgery performed?
Surgery is generally done in two stages. The first stage is the placement of the DBS lead or wire. To obtain the best result from surgery, the exact location of the DBS lead is very important. To this end most centers that do DBS surgery use state of the art computer guidance and brain mapping techniques to identify the perfect location for the DBS lead. To help find that exact location, a rigid frame or a “halo” is placed on the patients head during the surgery. The lead is placed through a small incision in the scalp and a small opening in the skull. The patients cooperation during the surgery is also very important in finding the perfect location for the DBS and therefore patients remain awake during the parts of the surgery where we would need their participation. For the remainder of the surgery, patients are under some anesthesia. Patients should not have any discomfort during any part of the procedure and part of the goal of the surgical team is to make sure that is the case for all patients. Usually on the day after the surgery, patients are discharged to home.
The second stage of the DBS procedure is the implantation of the battery and it is done usually about one to two weeks after the first stage. It is an outpatient surgery and patients are placed under complete anesthesia. Once the surgery is done, patients are discharged home on the same day.
Can the Surgery be done under general anesthesia?
HackensackUMC is one of only a handful of hospitals in the country that have the facilities and the expertise to perform MRI guided DBS surgeries. This technique allows us to perform the surgery under complete general anesthesia. There is no halo involved and patients do not have to remain awake during any part of the surgery. There is also no need to stop Parkinson’s medications prior to surgery adding to patient comfort.
When will the DBS start working?
About 4 weeks after surgery, the stimulator is turned on by the team. This is done in the office, with remote control communication with the brain pacemaker. About once a month, the stimulator is adjusted and within 4-6 months the settings will be stabilized. After this initial programming session, the required visits are for checking the system and are about once or twice a year.
Is there maintenance required for the system?
Once the settings are stabilized, the system should be checked about once or twice a year to ensure that it is working properly. The battery will need to be changed in about every 4-5 years, and this is also done as a same day procedure, and only requires a battery change and not any replacement of the brain lead.
What if I have undergone DBS and a cure is discovered?
DBS does not destroy or damage any part of the brain. It can be removed to allow for other procedures if gene therapy or transplant therapy prove to be better treatments or a cure for Parkinson’s disease.
Do I have to limit my activities after DBS?
The purpose of surgery is to restore a patients quality of life, and not to limit them from activities they enjoy. Patients can be active and even engage in sports after DBS.
How can I get more information about surgery?
There are some excellent sources of information for surgery for Parkinson’s Disease. The American Parkinson’s Disease Association, The Parkinson’s Alliance, and the National Parkinson’s foundation have great resources for people with Parkinson’s in general and also for surgery for Parkinson’s disease. Also reach out to a support group in your area. They could be a valuable source of information.
For more information about DBS at Hackensack University Medical Center, call The Department of Neurosurgery at 551-996-3221.