Deep Brain Stimulation for Parkinson's Disease
What Are the Advantages of Deep Brain Stimulation?
Deep brain stimulation has many advantages.
- First, it does not require purposeful destruction of any part of the brain and therefore, has fewer complications than thalamotomy and pallidotomy.
- In addition, the electrical stimulation is adjustable and can be changed as the person's disease changes or his or her response to medications change. No further surgery is necessary to make the adjustments.
- Another significant advantage of deep brain stimulation relates to future treatments. Destructive surgery, such as thalamotomy or pallidotomy, may reduce the person's potential to benefit from future therapies. For example, future brain cell transplantation may be of great help to people with Parkinson's disease. There is concern that a pallidotomy or thalamotomy may prevent patients from benefiting from brain cell transplantation. This would not be the case with deep brain stimulation, as the stimulator could be turned off.
- Deep brain stimulation is a relatively safe procedure.
- The procedure can treat all the major symptoms of Parkinson's disease.
- Daily living tasks and quality of life are also improved.
- With subthalamic nucleus stimulation, medications can usually be reduced.
- The stimulator can also be turned off at any time if deep brain stimulation is causing excessive side effects.
- Increased risk of infection. The implantation of any foreign object in the body carries that risk.
- Additional surgery may be needed if the equipment stops working or for battery replacement
- Additional time on the part of the patient and health care provider to program device and adjust medications
- Device may interfere with anti-theft devices, refrigerator door magnets.
How Effective Is Deep Brain Stimulation?
With deep brain stimulation, the vast majority of people (over 70%) experience a significant improvement of all their symptoms related to Parkinson's disease. Most people are able to significantly reduce their medications.
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.