Deep Brain Stimulation

People suffering from a variety of disabling neurological symptoms may now have hope, thanks to deep brain stimulation (DBS). A tiny device is surgically inserted to deliver electrical stimulation to the brain, which helps control movement and block the abnormal nerve cells that cause tremor, rigidity, stiffness and slowed movement. This procedure has proven to be an effective solution for patients with Parkinson’s disease, essential tremor, epilepsy, Tourette syndrome and dystonia that hasn’t responded to other treatment.

Treatment for Parkinson's disease begins with medications that help with symptoms like tremor, rigidity, and slowness. These symptoms happen because the disease is destroying brain cells that produce a chemical called dopamine that helps control movements. The medication can increase the amount of dopamine in the brain or mimic its effects. As time goes on, the symptoms of Parkinson's disease grow worse. You need to take a higher dose of your medication or additional medications that can have disturbing side effects. At that point, when medications are becoming less effective, it's time to talk with your doctor about deep brain stimulation therapy.

Learn more about deep brain stimulation

DBS offers improved movement control

Deep brain stimulation offers people with Parkinson’s disease greater freedom to live and work with the potential to improve their motor control, mobility and functional ability. It can also improve the lives of caregivers by reducing the burden posed by a loved one’s disorder and resulting disability. DBS therapy can reduce several motor symptoms associated with Parkinson’s disease, including

• Rigidity- stiffness or inflexibility of the limbs or joints
• Bradykinesia/akinesia- slowness of movement/absence of movement
• Tremor- involuntary, rhythmic shaking of a limb, the head or the entire body
• Dystonia - involuntary, painful muscle contractions

In one major study, DBS therapy was shown to increase periods of good mobility (no symptoms or involuntary excessive movements) from 27 percent to 74 percent. In another study, patients who chose DBS therapy maintained motor symptom improvements even after five years. Compared to medications alone, DBS therapy used in combination with medication has been found to reduce symptoms and some drug side effects.

Candidates for deep brain stimulation

DBS may be a treatment option for people who have Parkinson's disease and those who:

• Have responded well to the medication levodopa;
• Still receive benefit from medication, but notice that it's becoming less effective or causing intolerable side effects;
• Require multiple medications or more frequent doses to manage their symptoms, and,
• Have tremors not well controlled with medications.

As soon as medications begin to lose their effectiveness, it may be time to consider DBS. The “window of opportunity” closes when symptoms no longer respond to medications. In order to obtain maximum benefits from DBS, patients with Parkinson's disease should talk to their doctor about the optimal time for DBS therapy to be the most effective and how long the window of opportunity will be open.

How DBS works

Deep brain stimulation uses an implanted medical device, similar to a cardiac pacemaker, that delivers mild electrical pulses to precisely targeted areas of the brain involved in motor control and muscle function. Electrical stimulation of these areas normalizes the brain circuits that control movements. The stimulation can be programmed and adjusted non-invasively by a trained clinician to maximize symptom control and minimize side effects.

The DBS System consists of three implanted components:

• DBS Lead (see Figure A): A DBS lead is a thin, insulated, coiled wire with eight electrodes at the tip that is implanted in the brain; the electrodes are positioned in the target site for stimulation.
• Generator (see Figure B): A neurostimulator is a small, sealed device that contains a battery and electronics; it is implanted beneath the skin in the chest and produces the electrical pulses emitted through one or more of the electrodes.
• Extension: Like the lead, an extension is a thin, insulated, coiled wire. It is passed under the skin of the head and neck and connects to the lead at the top of the skull and to the neurostimulator in the chest.

How the DBS System is implanted

The surgery to implant the device involves surgery to implant an intracranial lead, surgery to implant the generator, and possible third surgery if bilateral therapy is needed.

Stimulation from the generator is easily adjustable—without further surgery—if the patient’s condition changes. And unlike previous surgeries for Parkinson's disease, DBS does not damage healthy brain tissue by destroying nerve cells. This means that if newer, more promising treatments develop in the future, the DBS procedure can be reversed. As with any brain surgery, there are risks associated with the implant procedure, so please talk with your physician about your health, goals and risks to make the best decision for you.

Make an appointment

Deep brain stimulation is performed at Cabell Huntington Hospital for patients across the country. For a consultation about deep brain stimulation and whether it may help you, please call 304.399.6819.