The recommendations below are a compilation of Dr. Izor and NSC staff, as well as adapted from Paul Marik, MD's MATH+ protocol. Dr. Marik is Chief of Pulmonary and Critical Care Medicine, Eastern Virg…Read More
Deep Brain Stimulation
Living with Parkinson’s
Parkinson’s disease is a progressive nervous system disorder that leads to tremors, muscle stiffness, and difficulty with balance, coordination, and walking. People may also experience slurred speech, difficulty writing, sleep problems, and depression. According to the Parkinson’s Foundation, anyone can have Parkinson’s disease, but it affects about 50 percent more men than women.
For most people, symptoms start to appear gradually and then proceed to get worse over time. While there is currently no cure for Parkinson’s, there are many treatments and medications that can offer relief from symptoms and improve your overall quality of life. Patients with minor symptoms can experience some relief through programs centered on exercise, nutrition, and medication. However, over time, this approach can lose its effectiveness, prompting the need for higher doses of medication and surgical treatment.
Parkinson’s disease affects each person differently, and the exact cause is still unknown. It is thought to be caused by a combination of factors including genetics and environmental triggers. A person’s age and sex also play a part in the development of the disease, with older adults and males having a higher incidence.
If you’ve been diagnosed with Parkinson’s, you’re not alone. In fact, approximately 60,000 Americans are diagnosed with the disease each year and according to the Parkinson’s Foundation, nearly one million people in the U.S. will be living with Parkinson’s by 2020. So what can you do if you’re living with Parkinson’s and medication is becoming less and less effective? Take a proactive approach and contact Neurology Solutions to learn more about Deep Brain Stimulation. Because the disease affects everyone differently, we’ll sit down with you to discuss your particular case and how DBS may be an integral part of your disease management plan.
What Is Deep Brain Stimulation (DBS)?
Deep Brain Stimulation is a procedure that involves surgically implanting electrodes into a targeted area of the brain along with an implanted pulse generator that is placed beneath the skin of the abdomen. The pulse generator provides electrical impulses to the part of the brain involved in motor function and works to block the signals that cause Parkinson’s symptoms. DBS is a complex treatment that requires consistent monitoring, but it has been shown to be effective in stabilizing symptoms, reducing the need for medications, and providing a way to more consistently manage the disease.
Deep Brain Stimulation surgery was first approved in 1997 to treat Parkinson’s tremors. In 2002, it was approved for the treatment of advanced Parkinson’s symptoms and then in 2016 DBS was approved for earlier stages of the disease.
How Does DBS Work?
Deep Brain Stimulation is one of the most promising treatments for Parkinson’s disease patients whose symptoms can’t be adequately controlled with medications. But, just the name of this procedure can leave many people feeling uneasy and afraid. After all, any kind of brain surgery is complex and comes with some risk. Here at Neurology Solutions Movement Disorders Center of Austin, you can be confident in the experience and skill of our surgical team knowing that we’ve helped hundreds of patients get relief from their symptoms and enjoy a better quality of life.
If you’re interested in learning more about DBS and whether or not it could be a good option for you, the first question you might have is, “what happens during the procedure?” While the treatment may sound like a radical one, we want to explain how it works and what you can expect before, during, and after your surgery.
Before your surgery, you and your doctor will meet to discuss your treatment plan, review the risks and benefits of DBS, and what you should expect during and after your surgery. A few days before your surgery is scheduled, your doctor will create high-resolution imaging and maps of your brain to help assist with the surgery and guide the placement of the electrodes.
During your surgery, you may be placed under light sedation, but you won’t be asleep. This is necessary to perform a stimulation test to ensure proper placement of the electrodes. The DBS device is comprised of two components — electrodes consisting of very thin wires which are permanently implanted into the target area of the brain and an implanted pulse generator (similar to a pacemaker) which is placed beneath the skin of the abdomen. The pulse generator delivers electrical stimulation to targeted areas of the brain in an effort to block the abnormal nerve signals that cause movement disorders related to Parkinson’s Disease.
Once the target areas are located, your doctor will confirm the proper location of the electrodes and the stimulation strength by asking you to perform different functions, such as raising your arm or leg or moving your fingers or wrist. After the precise locations are identified, the electrodes will be permanently implanted. Most patients can expect the entire procedure to take four to six hours.
The second component, the implanted pulse generator (also called the neurotransmitter) will be placed under the skin of the abdomen approximately one week after the electrodes are implanted. The extension wire is tunneled under the skin of the head, neck, and shoulder and connected to the neurostimulator. This is an outpatient surgery performed under general anesthesia with most people being able to go home the same day.
If you would like to learn more about DBS surgery, you can get more detailed information by contacting a member of our team at Neurology Solutions Movement Disorders Center or you can also refer to the Parkinson Foundation’s guide to Deep Brain Stimulation.
Beginning the following day after your surgery, you will have multiple visits with our highly trained staff to adjust the stimulator to best control your symptoms while minimizing side effects. It is important to be patient during this time. Don’t expect to have immediate relief from symptoms. It will take a few programming sessions to dial into the optimum settings and give your brain a chance to adjust.
What to Expect After DBS
One of the biggest benefits of choosing Deep Brain Stimulation is that the device can be adjusted as many times as necessary to meet your needs. Parkinson’s is a disease that affects people differently. Not everyone will have the same symptoms, and the onset, duration, and management of these symptoms can vary widely from person to person. DBS allows your doctor to address and treat your unique case. The device can be programmed and reprogrammed to provide you with the greatest benefit and it can be readjusted as your symptoms change.
After your DBS surgery, you will have programming appointments with the NCS team to adjust your DBS system and make sure that it is working properly. Other than making time for your scheduled appointments, you shouldn’t have to worry about any other additional maintenance. Once your deep brain stimulation surgery is over and you’ve received the okay from your doctor, you should be able to return to your usual daily activities. Unlike medication or other therapies, the DBS system works automatically so you shouldn’t have to worry about turning it on or off or limiting your activities.
Awake Vs. Asleep DBS
As you continue to research your various options for Parkinson’s symptoms treatment, you’ll likely come across the current controversy over awake and asleep DBS, and discussion on which method is more effective. At Neurology Solutions, we believe that having the patient awake during the procedure is the best method. While most patients don’t like to think of being awake during this type of surgery, keep in mind that you will be sedated and the brain experiences no pain during stimulation.
Awake DBS is a better option for patients for several reasons, but the most important being that they can provide feedback which can greatly enhance the success of the procedure. When a patient is awake, they can provide real-time feedback to the surgeon to let them know how the deep brain stimulation is working. With asleep DBS, it is unknown whether or not the electrodes have been placed in the correct areas until after the surgery and the patient is awake. Keep in mind that if the placement is off by even a millimeter, the full effectiveness of the procedure may not be recognized.
If you’re anxious about being awake during your surgery, we understand and want to help put your mind at ease. Keep in mind that we can give you adequate medication to help reduce anxiety and even provide partial sedation.
Are You a Good Candidate for DBS?
Patients seeking alternative treatments like Deep Brain Stimulation surgery often find that their current medication isn’t effectively controlling their symptoms for the full duration. They are also seeking alternative options when medications aren’t well tolerated and cause additional side effects.
In the past, DBS surgery was considered when medication was no longer effectively controlling symptoms. However, in 2016, the FDA approved Deep Brain Stimulation for people in earlier stages of the disease. If you have Parkinson’s, besides decreasing tremors, rigidity, and slowness of movements, DBS can reduce the need for medications. But not everyone is a candidate. Here are a few of the criteria you’ll have to meet in order to be considered for DBS surgery:
- It has been at least four years since you were diagnosed with Parkinson’s, with exception of tremor dominant symptoms.
- You have a good response to Parkinson’s medications with regard to gait, rigidity and slowing.
- Your symptoms are not adequately controlled with medication.
About Neurology Solutions Movement Disorders Center
What We Offer
At Neurology Solutions of Austin, we offer comprehensive therapies for the treatment of movement disorders such as Parkinson’s Disease. We provide physical, behavioral, cognitive, and surgical methods for managing and treating a wide range of movement problems. As a patient of Neurology Solutions, you’ll receive access to many resources including a trained medical team specialized in movement disorders. Neurology Solutions also collaborates with Dr. Patel and his team at the Department of Neurosurgery at St. David’s North. A fellowship-trained specialist in movement disorders, Dr. Izor founded Neurology Solutions in 2004 and has participated in DBS surgeries that have helped over 200 patients. If you’ve chosen to undergo Deep Brain Stimulation surgery as part of your treatment plan, rest assured that you’ll be in good hands with Dr. Izor.
Our DBS Support Group Makes All the Difference
Choosing to undergo Deep Brain Stimulation surgery is a very serious decision that only you can make. Researching DBS, going through the process to determine whether or not you’re a candidate, and undergoing the DBS procedure can be a long and stressful process. No matter what stage of the journey you’re in, we believe that joining a support group can be highly beneficial for patients and caregivers alike.
At Neurology Solutions, we sponsor a monthly deep brain stimulation support group as a way for people with Parkinson’s to connect with other people who have already undergone DBS surgery. It gives people considering the treatment the information and guidance they need in a welcoming and supportive environment.
Contact Neurology Solutions
If you’re considering Deep Brain Stimulation for the treatment of Parkinson’s symptoms and have questions about the procedure or want to know if you would be a good candidate, contact Neurology Solutions. You can also visit our website to get useful information or join our email list to stay up to date on the latest treatments.