Dystonia, Essential Tremor, Parkinson’s disease considered for DBS surgery
By Karen Hales, Neurology Solutions Contributing Writer
Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of debilitating neurological symptoms common to movement disorders such as Parkinson’s disease (PD), essential tremor and dystonia. Patients with a movement disorder often consider DBS implant surgery to stabilize their symptoms, reduce the need for medications and to provide more consistent relief of symptoms in medication off-periods.
Click here to complete the “Are You A Candidate for DBS?” questionnaire.
What is Deep Brain Stimulation?
In DBS, thin insulated wires called electrodes are implanted into one or both sides of the brain to stimulate areas of the brain that control movement. These areas—the motor cortex, premotor cortex and sensory areas—pass through the basal ganglia and help modulate muscle tone, the smoothness of voluntary movement and the involuntary “positional sense” (the ability to know where our body is at all times).
The DBS device is comprised of two components, a DBS electrode that is permanently implanted into the target structure in the brain and an Implanted Pulse Generator (IPG) placed beneath the collarbone. Following implantation, the electrodes are connected to the IPG, also known as a “stimulator.” An external programmer is used to communicate with the IPG to program delivery of electrical signals through a wire to a small brain region to block the signals that cause some Parkinson’s symptoms. DBS is a relatively complex therapy that requires consistent monitoring by your doctor and battery replacement every 3-4 years.
The DBS procedure, called stereotactic brain surgery, is performed with a computer system that integrates previous imaging performed one or two days before the surgery that provides a 3-dimensional image of the brain. The surgeon will use this image along with instruments that provide visual monitoring of the brain during surgery to guide the trajectory and target where the DBS wire will be placed.
The surgeon also will use Micro Electric Recording (MER) to precisely identify the surgical site for implantation of the wire. The MER technique uses electrical current at a very high frequency (300Hz) that allows the surgical team to visualize and hear the neuronal activity from different areas of the brain to identify specific structures.
Patients are awake under light sedation during the deep brain stimulation surgery to allow the neurosurgeon and attending neurologist to monitor electrical activity in the brain during the procedure. The surgeon will perform test stimulation of the area prior to permanent placement of the lead to test for any side effects and benefits of stimulation.
The doctor programs the pulse generator settings with a wireless device, and the patient uses a handheld controller to turn the DBS system on and off. The stimulation settings—size, shape and intensity of field—can be adjusted as a patient’s condition changes over time, and the individual will likely see their neurologist once per month for the first year and every three to six months in subsequent years to monitor the effectiveness of the DBS settings.
Unlike other brain surgeries to address movement disorders, such as pallidotomy or thalamotomy, DBS does not damage the brain tissue. Thus, if better treatments develop in the future, the DBS procedure can be reversed. For additional information, download the National Parkinson Foundation’s Guide to DBS Therapy.
DBS Support Group Sets Expectations
Neurology Solutions Movement Disorders Center leads a DBS Support Group for individuals who have undergone DBS and those who are considering the surgery. The support group, sponsored by the Capital Area Parkinson’s Society, meets at 2 p.m. the third Friday of the month at Neurology Solutions, 12345 North Lamar Blvd., Suite 260, Austin, Texas.
If you are seeking another opinion on managing your symptoms from Parkinson’s disease, dystonia, essential tremor or an age-related movement disorder, call 512-865-6310 to make an appointment with Neurology Solutions.
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