Deep brain stimulation for Parkinson’s disease
651/326-3415

St. Joseph's Hospital offers deep brain stimulation (DBS) for patients with advanced Parkinson’ disease. Parkinson's disease is a progressive and degenerative neurological disorder that causes loss of control over body movements.

DBS uses one or two surgically implanted medical devices called neurostimulators, similar to cardiac pacemakers, to deliver electrical stimulation to precisely targeted areas on each side of the brain. Stimulation of these areas appears to block the signals that cause the disabling motor symptoms of Parkinson's disease. As a result, many patients achieve greater control over their body movements.

Understanding Parkinson’s disease

The cause of Parkinson's disease is unknown and there is no cure at this time. Symptoms of Parkinson's arise when a small region of the brain called the substantia nigra degenerates. Neurons (brain cells) in the substantia nigra die, depriving the brain of the chemical dopamine. Dopamine is a neurotransmitter that enables communication among the brain cells involved in motor control. Reduced levels of dopamine lead to the motor control symptoms associated with Parkinson's.

Patients with Parkinson’s can experience extreme swings in movement control - from periods of virtually normal motor function to episodes of complete immobility - in the span of a few hours.

As Parkinson's progresses, it becomes increasingly disabling, making routine daily activities like bathing, dressing or eating without assistance from others difficult or impossible.

Benefits of deep brain stimulation

• DBS can provide hours of relief from the debilitating slowness, stiffness and/or shaking of Parkinson's disease every day. It can also reduce the duration of the abnormal, involuntary movements (dyskinesias) that are a common side effect of Parkinson's medications.

• DBS is reversible. If a cure for Parkinson's disease is developed, the therapy can be turned off and the system can be removed. In addition, DBS is adjustable. This means that the stimulation can be changed over time to best match the need for symptom control. To adjust the stimulation, a physician uses a programmer that communicates non-invasively with the neurostimulator through radio frequency.

For more information on deep brain stimulation

If you'd like more information on deep brain stimulation, contact the HealthEast Neurovascular Institute at 651/326-3415.

The image and information in this section was provided by Medtronic, the maker of Activa Therapy, a deep brain stimulation system.

Deep Brain Stimulation

Is deep brain stimulation (DBS) right for me?

If you're interested in DBS, the following points are often used to determine if you are a candidate. Remember, only a physician can determine if DBS is right for you.

You may be a candidate if:

• Your Parkinson's drugs are no longer working well and you are suffering from their side effects.
• You have shown benefit now, or in the past, from levodopa therapy.
• Your symptoms are not adequately controlled by medications.
• You do not have significant cognitive decline or dementia.

You must also:

• Be physically able to endure the surgery, and must be able to cooperate by answering questions and following directions during the surgery.
• Understand the nature of the therapy and be able to operate the Neurostimulator Control Magnet or Access Review Therapy Controller.
• Be available for periodic follow-up visits.
  

Deep Brain Stimulation

Surgical procedure for deep brain stimulation (DBS)

A Parkinson's care team consisting of a neurologist, neurosurgeon and team of nurses is involved in caring for DBS patients. The DBS system is implanted by a functional stereotactic neurosurgeon (a neurosurgeon who specializes in treating central nervous system function disorders using stereotactic techniques). This means that a stereotactic head frame is used to keep your head still during surgery and the neurosurgeon uses special imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) to map the brain and locate the site to be stimulated - either the subthalamic nucleus (STN) or the internal globus pallidus (GPi). These structures are deep within the brain and involved in motor control. They control movement and muscle function.

There are two parts to the surgery: the procedure to implant the leads, and the surgery to implant the neurostimulator(s) and extensions. The duration of the procedure and the specific steps involved can vary. The first surgery will last, on average, about four hours. However, some surgeries can last up to eight hours. The second surgery lasts about one hour.

Although the prospect of surgery can be scary, there is some comfort in knowing that patients who have DBS usually describe the surgery as demanding and exhausting, but not painful. Many patients have said it was well worth it. Fortunately, the brain itself has no pain receptors and feels no pain.

The hospital stay is usually a few days for the pre-operative tests, implant surgery and recovery. The hospital stay for the first surgery is anywhere from one to three days. The hospital stay after the second surgery is usually less than 24 hours.

Follow up: Programming and deep brain stimulation

After surgery, follow up visits are necessary. This is because the computer chip inside the neurostimulator must be programmed to send the electrical pulses to help control Parkinson's disease symptoms.

The physician or nurse uses a programmer to non-invasively program (transmit instructions to) the DBS system. People respond to DBS in their own way and the program for the neurostimulator is customized to each patient's needs.

Visits to the clinic for initial programming after surgery and periodic adjustments are a routine part of DBS. It will take several visits to adjust the stimulation and medication before the right combination is determined. As you become accustomed to DBS and your body fully heals, further adjustments will be needed. Over time, as the disease progresses, further adjustments may be necessary. Ongoing, periodic visits are a routine part of the process.

Deep Brain Stimulation

Questions to ask your doctor

If you are considering deep brain stimulation (DBS), here are some questions you may want to ask your doctor.

• Am I a candidate for this therapy? Why? Why not?
• What are the potential risks and benefits of the therapy?
• What are the potential risks of the surgery?
• What are the side effects of the therapy? Can the side effects be controlled?
• What kinds of tests will be conducted before the surgery?
• What can I expect the day of surgery?
• How long does the surgery last? Is it painful?
• How long will I need to be hospitalized?
• Will my condition improve immediately after surgery, or will it take more time?
• What precautions will I need to take after surgery?
• How often will I need to return for follow-up visits? How many programming sessions to adjust the stimulation can I expect?
• Will I still need to take medication after having DBS?
• How much does this therapy cost? Is it covered by insurance or Medicare?

Here are some other things to keep in mind when talking with physicians who provide deep brain stimulation:

Training
What is the physician's training and how many years has he or she been in practice?

Experience
What is the physician's experience in DBS? How would the physician describe the satisfaction level of implanted patients?

Location
How frequently will you need to follow-up for programming? Where will the follow- up take place?

Comfort Level
How comfortable are you with the physician? Do you feel your questions and concerns are addressed?