In some cases where a person with Parkinson’s disease is not responding well to medication, they may be offered treatment through surgery. There are a few surgical options, but the most common surgery for Parkinson’s disease is deep brain stimulation (DBS).
Deep brain stimulation (DBS)
DBS is a non-destructive surgical treatment for Parkinson’s disease that involves implanting a device to stimulate targeted regions of the brain with electrical impulses generated by a battery-operated neurostimulator.
Why would you be recommended for DBS?
DBS is used for the treatment of motor symptoms in Parkinson’s disease, such as tremor, rigidity, stiffness, slowed movement and walking problems. It is generally only offered to patients who have had Parkinson’s disease for at least four years and after other avenues of medication have been tried and failed to fully control the symptoms. These patients may be those who experience a significant “off” time or have severe dyskinesia (involuntary movements) as a result of long-term levodopa usage.
Prior to the surgery
Before being recommended for surgery, Parkinson’s patients will undergo an extensive assessment to ensure the surgery is right for them.
Prior to the actual DBS surgery, the surgeon will use other procedures such as magnetic resonance imaging (MRI) or computed tomography (CT) scanning to map the brain and identify the target area for DBS.
What happens during the surgery?
The surgery is generally carried out in two stages. First, a local anesthetic is applied to the scalp before surgery and very fine wires (with electrodes at the tips to deliver electrical signals) are inserted into the brain at the targeted region.
The second stage may be carried out under general anesthesia. A wire is implanted to connect the electrodes to a neurostimulator, which generates the electrical pulse that is delivered by the electrodes. The neurostimulator is generally implanted below the collarbone, but can also be placed in the lower chest.
Once the device has been implanted, the symptoms can be monitored and the setting of the neurostimulator can be adjusted to best suit the patient’s needs. Re-programming is noninvasive because it can be performed wirelessly using an antenna held near the site of the neurotransmitter.
What are the benefits?
It is believed that the electrical signals generated by DBS interrupt the abnormal signaling patterns in the brain that causes the issues with motor control.
DBS is not a cure for Parkinson’s disease, nor does it stop the progression of the disease, but many patients experience a significant reduction in their symptoms following surgery. Most patients will still need to take medication after the surgery, but DBS may lead to a reduction in the amount required. This in turn can reduce medication-induced side effects, such as dyskinesia.
What are the risks associated with DBS?
The risks associated with DBS can vary depending on the underlying medical condition and should be fully discussed with the neurologist before surgery to ensure the procedure is safe.
DBS is generally safe, but there are some risks associated with it. For example, some patients have reported speech issues or experienced cognitive decline following DBS, and there is a low risk (1 to 3 percent) of complications due to anesthesia, infection, stroke, or cranial bleeding.
In the past, surgical treatments for Parkinson’s disease involved the destruction of targeted areas of the brain (lesioning) that contribute to the symptoms. These are named after the region of the brain targeted and can include a thalamotomy, pallidotomy, and sub-thalamotomy. These procedures have a much longer recovery time compared to DBS and are irreversible. They are rarely performed now and have mostly been replaced by DBS.
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