Common Misconceptions about Deep Brain Stimulation
by: Kara Beasley, DO
Deep Brain Stimulation (DBS) is a surgical treatment for movement disorders such as Parkinson’s disease (PD), essential tremor (ET) and dystonia. In Parkinson’s disease, DBS is best suited for patients whose medication fails to provide adequate symptom control or in whom medications cause intolerable side effects.
Parkinson’s patients who undergo DBS typically experience a dramatic reduction in their medications and more consistent motor function. They typically have a more fluid movement without the highs and lows of medications wearing off. DBS will reduce rigidity, improve bradykinesia (slowness), improve akinesia (freezing) and diminish tremors. The dyskinesias usually resolve due to medication reduction. DBS is also very effective for patients with essential tremor, eliminating the need for medications and reducing tremor by 60-90%.
DBS provides a constant, high frequency electrical signal to a specific area of the brain, which overrides the abnormal circuitry in the brains of patients with movement disorders, providing therapeutic benefits for many symptoms associated with these diseases.
Some common concerns and misconceptions about DBS
My condition is not bad enough to necessitate DBS.
In Parkinson’s disease, there is a window of opportunity wherein one can undergo DBS. If a patient has progressed to moderate or severe dementia, DBS is not an option. Furthermore, DBS is appropriate when medication still has a positive effect but is becoming less reliable, or, when side effects are intolerable. Once medications are ineffective, DBS will not be a treatment option. One should inquire about DBS when PD symptoms and effectiveness of medications change, and before dementia sets in. A neurosurgeon or neurologist can help to monitor your symptoms. DBS does not cure PD, and if it progresses we can fine tune programming for continued effectiveness.
DBS is experimental and should be used as a last resort.
DBS has been approved in the US for more than 10 years, since 1997. There are over 100,000 patients with DBS worldwide. In the case of essential tremor, the American Academy of Neurology recommends DBS for a 60-to-90 percent improvement in limb tremor. For PD, DBS has now been proven to provide better motor symptom control than medications alone, as well as lead to reductions in medication and improved quality of life. The risks of DBS are too high. The rate of infection for this procedure is three-to-five percent over the course of a patient’s lifetime. The risk of stroke is less than 1%. This procedure has been proven to be safe and effective in the treatment of Parkinson’s disease, dystonia and essential tremor. It is in fact the gold standard in treatment of Parkinson’s disease. There is minimal post operative pain and most patients spend only one night in the hospital.
The battery needs to be replaced often and will include an invasive procedure.
Generator replacement takes 15 minutes, can be accomplished under local anesthesia and is done every three-to-five years on average.
Once I have DBS I cannot try any new treatments in the future.
DBS is reversible and if more advanced treatment options for movement disorders become available, all of the hardware can be removed. DBS only works for tremor. DBS also helps with stiffness, slowness and freezing associated with movement disorders such as PD, and is also effective for essential tremor and dystonia. If my doctor hasn’t recommended DBS I must not be a good candidate. Often medical doctors may not recommend procedures they are not familiar with and they may not be educated on this advanced technology. If you have questions about DBS you can schedule a consultation with a neurosurgeon to evaluate your candidacy. You can also ask your doctor if this therapy might be right for you.
I cannot afford DBS.
DBS is covered by all major insurances, including Medicare and Medicaid.