Benefits of DBS may be just as promising for early stages of Parkinson’s
By Karen Hales, Neurology Solutions Contributing Writer
Deep brain stimulation surgery for Parkinson’s disease is generally considered when quality of life is no longer acceptable and medicine no longer addresses the neurodegenerative disorder’s symptoms effectively. However, anyone who would get significant benefit from the treatment and can undergo the DBS operation with minimal risk should consider DBS. A European research study of patients who had been living with the disorder an average of 7.5 years indicates that deep brain stimulation’s benefits may be just as promising for people in the earlier stages of Parkinson’s.
Criteria for Deep Brain Stimulation Surgery
An ideal candidate for DBS surgery is under 70 years old and is in good health. Patients who fluctuate between “on” and “off” medication states are usually good surgical candidates, as are those who have troublesome dyskinesias.
Your doctors will complete a formal evaluation to determine if you are a proper candidate for the surgery. The evaluation will including an MRI, physical and neurological testing, and an appointment with a neuropsychologist to ensure you are mentally and emotionally prepared for the procedure. Click here to complete the “Are You A Candidate for DBS?” questionnaire.
Conditions Treated with Deep Brain Stimulation Therapy
Parkinson’s disease is a movement disorder caused by nerve damage in the substantia nigra, the area of the brain that controls voluntary movement and regulates mood. This process of impairment of brain cells is called neurodegeneration. The nerve damage of PD impairs the cells’ ability to produce and deliver dopamine, a chemical that relays messages between the substantia nigra and other parts of the brain to control movements of the body. PD is the second most common neurodegenerative disorder next to Alzheimer’s disease.
PD often presents itself with tremor, or shaking, usually in one limb, such as a hand or finger. It is often preceded by non-motor symptoms such as sleep disorders, hyposmia (the loss of sense of smell) and constipation. By the time early Parkinson’s disease is diagnosed, it is estimated the person has lost 70% of the cells that produce dopamine.
PD is characterized by four main criteria:
- Resting tremor
- Slowness of Movement; and
- Postural instability
Doctors treating PD deal with a wide spectrum of disease. Some patients with PD present mainly with tremor for several years and have very little cognitive or behavioral issues. A large percentage of patients also experience a number of non-motor symptoms, including depression, apathy and psychiatric disturbances such as hallucinations.
DBS is a highly effective therapy for patients with essential tremor, often resulting in an 80% decrease in tremor that lasts for several years.
Tremor is the most common movement disorder. Tremor affects approximately 7% of the population, predominantly people age 65 and older. Essential tremor is characterized by uncontrollable shaking in different parts and on different sides of the body. Areas affected include the arms, hands, fingers, head, larynx, tongue and chin. The lower body is generally not affected by ET.
Essential tremor is thought to be caused by electrical fluctuations in the brain that send abnormal signals out to the muscles. Several areas of the brain have been implicated in generating these signals. The signals travel through a variety of brain regions including the cerebellum, red nucleus, globus pallidus, thalamus and cortex, before they make it to the muscles.
DBS also is a treatment of choice for managing symptoms of dystonia. Dystonia is the term used to describe uncontrollable and sometimes painful muscle spasms caused by incorrect signals from the brain. Dystonia is characterized by involuntary sustained muscle contractions, abnormal movements or postures, or both.
Primary, generalized and segmental dystonias respond best to DBS. Primary dystonia (DYT1) describes a case in which the dystonia is the only neurological disorder that the person has. It is generally considered to be due to hereditary or genetic influences.
Secondary dystonias that occur from head trauma, stroke, infection or Multiple Sclerosis are less likely to benefit from deep brain stimulation surgery.
Other conditions treated with DBS
DBS therapy is also used to treat chronic conditions including chronic pain, chronic or cluster headaches, severe depression, obsessive compulsive disorder and Tourette’s Syndrome.
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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