Therapies and Treatments

Manage symptoms and help slow the progression of Parkinson’s disease through various therapies and treatments.

Deep Brain Stimulation (DBS)

Deep Brain Stimulation, or DBS, is a surgical therapy that is used to treat some aspects of Parkinson’s Disease. It is a powerful therapy that addresses movement symptoms of Parkinsonism and other side effects cause by medications. DBS might also improve non-motor symptoms such as sleep issues, pain and urinary urgency. It is important to note that DBS can help relieve certain symptoms, but it is not a cure or stop of disease progression. The U.S. Food and Drug Administration approved DBS in 1997 to tream tremors, in 2002 to treat advanced symptoms, and in 2016 for earlier stages of Parkinson’s for people who have had the disease for at least four years and have motor symptoms that are not adequately controlled with medication.

Deep Brain Stimulation is perhaps the most important therapeutic advancement in the fight against Parkinson’s Disease since the development of Levodopa. It has the greatest effect for people experiencing disabling tremors, medication-induced dyskinesias, wearing-off spells, with studies showing benefits that can last five years. However, DBS is not the right solution for every person with Parkinson’s because many issues, such as speech, swallowing, thinking, or gait troubles, do not respond well to DBS therapy.

As with all brain surgeries, there are risks associated with DBS surgery including the risk of infection, bleeding, seizure or stroke. This surgery may also be associated with a reduced clarity of speech and possibly with changes in finding the right words. In a small number of cases, patients have experienced cognitive decline after a DBS procedure. It is important that a Parkinson’s patient considering this therapy be well informed about the procedure and realistic about their expectations.

How DBS works

During a DBS procedure, electrodes are inserted into a specific target area of the brain, using magnetic resonance imaging and recordings of brain cell activity during the procedure. A second procedure is them performed to implant an IPG (impulse generator battery), similar to a heart pacemaker and about the size of a stopwatch. The IPG is placed under the collarbone, or in the abdomen, and delivers an electrical stimulation to targeted areas in the brain that control movement. Patients who undergo a DBS procedure are given a controller to manage the device (on or off) and monitor basic parameters such as battery life.

The DBS system consists of three components: the Lead, the Extension and the Neurostimulator. The lead, also referred to as an electrode, is a thin, insulated wire inserted through a small opening in the skull and implanted in a target area of the brain. The extension is an insulated wire that is passed under the skin of the head, neck and shoulder, that connects the lead to the neurostimulator (IPG). The neurostimulator, the battery pack so to speak, is implanted under the skin near the collarbone, lower in the chest or under the skin over the abdomen.

Are you a good candidate?

Although many people will experience considerable reduction of their Parkinson’s disease symptoms and can reduce their medication, most people will still need to take medication after undergoing a DBS procedure. The reduction in the amount of medications will vary from person to person and can lead to a decreased risk of side effects such as dyskinesia. Although quite low (1 - 3%), there is a chance of infection, bleeding in the brain, stroke, or other complications associated with general anesthesia. It is always advized for you to discuss the procedure and associated risks with your movement disorder specialist, neurologist and neurosurgeon. Other medical factors that may influence these risks and the decision to pursue surgery include diabetes, lung conditions and also heart conditions.

Questions to consider whether you might be a candidate for DBS

> Have you had PD symptoms for at least four years?

> Are you unable to tolerate Parkinson’s medications due to side effects?

> Do your Parkinson’s symptoms interfere with daily activities?

> Do you experience on/off fluctuations despite regular medication?

> Do you experience tremor that is not adequately controlled with medication?

> Do you experience dyskinesias? (A number of patients with dyskinesias don’t find them bothersome)

> Do you have a good response to medications (namely carbidopa/levodopa) even though the duration of the response is insufficient?

> Have you tried different combinations of medications under the advisement of a movement disorder specialist?