Deep Brain Stimulation for Parkinson's Disease
What Kinds of Movement Problems Are Helped by Deep Brain Stimulation?
Deep brain stimulation of the subthalamic nucleus is effective for all major symptoms of Parkinson's disease, such as tremor, slowness of movement, rigidity, and problems with walking and balance. People bothered by involuntary movements such as dyskinesia often experience a marked reduction of these involuntary movements primarily because they are able to reduce their medications following surgery.
Deep brain stimulation of the globus pallidus is effective for a wide range of Parkinson's symptoms. It seems to be somewhat less effective for problems with walking and balance. Also, patients remain on the same average dose of medications following surgery.
Deep brain stimulation of the thalamus is only effective for tremor and rigidity. Consequently, deep brain stimulation of the thalamus is usually not performed for patients with Parkinson's disease.
What Are the Risks of Deep Brain Stimulation?
As with any surgical procedure, there are risks. There is a 2%-3% risk of a serious and permanent complication such as paralysis, changes in thinking, memory and personality, seizures, and infection. Talk to your doctor to see if these risks apply to you.
Is Deep Brain Stimulation Experimental?
No. Deep brain stimulation is not experimental. DBS of the thalamus was approved by the FDA for the treatment of Parkinson's disease and essential tremor in 1997. But, since stimulation of the thalamus is only effective for treating tremor and rigidity symptoms, it is not recommended for the treatment of Parkinson's disease. This is because even if a person currently only has tremor or rigidity, he or she will eventually develop other symptoms that would only be helped by stimulation of the subthalamic nucleus or globus pallidus. Therefore, stimulation of the subthalamic nucleus or globus pallidus is recommended.
Who Should Consider Deep Brain Stimulation?
There are many important issues to be addressed when considering deep brain stimulation. These issues should be discussed with a movement disorders expert or a specially trained neurologist. A movement disorders expert is someone who has trained specifically in movement disorders.
One of the most important criteria is that the person has had an adequate trial of medications. Surgery is not recommended if medications can adequately control the disease. However, surgery should be considered for people who do not achieve satisfactory control with drugs. Talk to your doctor to see if DBS is right for you.