Parkinson’s Disease Surgery: Deep Brain Stimulation
When the best drug combinations no longer effectively control Parkinson’s symptoms, surgery may be used. Deep Brain Stimulation (DBS) is the most commonly performed operation.
Like all existing therapies for Parkinson’s disease, deep brain stimulation has no effect on the progression of the disease. However, it can help you better manage your tremors, slow movements, OFF periods and dyskinesias.
Surgery for Parkinson’s disease is limited to certain patients. If you are considering deep brain stimulation surgery, you should have realistic expectations about the results. This technique does not result in a complete cure and results vary from person to person
A multidisciplinary team consisting of a specialized neurologist, neurosurgeon, psychiatrist and other health care professionals can assess your eligibility and explain the benefits and risks of this procedure.
Deep brain stimulation is a surgical procedure that involves implanting one or two electrodes in a part of the brain that controls movement. These electrodes deliver electrical impulses that allow the brain to better control movements while reducing the dose of levodopa. Different parameters of the stimulator are adjustable to regulate its effect according to the progression of symptoms.
The electrodes are connected to a stimulator and a battery placed under the skin, near the shoulder.
Deep brain stimulation does not cure Parkinson’s disease or stop the degeneration of dopaminergic neurons.
Think of your best ON episode, i.e. when levodopa is most effective. This response is a good indicator of the best possible effect of deep brain stimulation on the extent and intensity of your symptoms.
Deep brain stimulation should significantly increase your ON time during the day and reduce your motor fluctuations. Your daily dose of levodopa should then decrease by half and therefore your dyskinesias caused by levodopa overdoses should partially disappear.
Deep brain stimulation substantially improves the quality of life of most patients who undergo surgery and usually gives them more autonomy in the performance of daily tasks.
However, this surgical procedure does not improve or only slightly improves Parkinson’s disease non-motor symptoms. Your symptoms that are unaffected by levodopa will most likely not improve after surgery.
People over the age of 70 and those with a history of depression or dementia are not eligible for deep brain stimulation. To find out if you qualify for this surgery, make a list of the symptoms that bother you the most. Your neurologist can review this list with you and may decide that this procedure would not reduce these symptoms. A multidisciplinary team can determine if you are a good candidate for deep brain stimulation based on:
- Your age
- How long you have had the disease
- Type and extent of symptoms that may or may not respond to levodopa treatment
- Cognitive and psychiatric disorders
- Other disease
- Post-operative complication risks
- Presence of social support such as a caregiver
Deep brain stimulation is safe and effective in suitable patients. Risks and side effects are rare but they differ over time:
- Brain hemorrhage (<5%)
- Stroke (<0.5%)
- Vagal shock and syncope (<0.5%)
Within two weeks after the operation:
- Headache (<5%)
- Partial paralysis of a part of the body (<2%)
- Confusion (<2%)
- Hallucinations (<0.5%)
In the following weeks:
- Wound infections (<5%)
- Device malfunctions (<4%)
- Loss of efficiency over time (<4%)
- Temporary tingling in the face or limbs
- A feeling of muscle tension
- Problems with speech or vision
- Loss of balance
Deep brain stimulation is usually done in two steps. The first procedure consists of inserting the electrodes into the brain and usually requires you to stay in the hospital for a few days.
The second procedure, which consists of implanting the stimulator and batteries, is minor. You should be able to return home quickly. Depending on the model, the stimulator batteries may need to be recharged or replaced within three to five years.
The stimulator is not activated immediately after the surgery.
During the appointment with your specialized neurologist within two weeks of the operation, your stimulator will be activated. The medical team will then try different electrical current adjustments to maximize symptom control and minimize side effects.
In the next two months, your medical team will gradually increase the intensity of the electrical current and decrease your doses of levodopa. This adjustment period may take several months before you get the most out of this procedure.
Some devices allow patients to change the current intensity themselves according to their daily activities. In the near future, these DBS systems will be able to automatically adjust their intensity according to your needs.
Thalamotomies and pallidotomies are other surgeries that can reduce the symptoms of Parkinson’s disease. They involve inducing a lesion in certain areas of the brain that are known to cause certain symptoms of the disease.
Thalamotomies are mainly used to reduce tremor. Pallidotomies are used for patients whose dyskinesias are the major problem. These surgeries are not as common as DBS and do not significantly improve posture, balance and walking disorders.
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