If you can't find a way to control Parkinson's motor fluctuations -- symptoms that return after taking medicine for years -- your doctor may suggest surgery called deep brain stimulation (DBS). It's not for everyone, so you'll need to talk over the pros and cons carefully. But if you decide to go forward with it, you could get relief from tremors, stiffness, and other problems.
Is Deep Brain Stimulation Right for Me?
If you get DBS, a surgeon puts electrodes into your brain to prevent the abnormal signals that cause Parkinson's symptoms.
The procedure might be an option for you if:
- You've had Parkinson's disease for more than 5 years.
- You have "off" and "on" periods where your symptoms come and go, even though you take medicine every day.
- Symptoms like tremor, stiffness, and slowness get in the way of your daily life.
- Your medicine dose wears off before it's time to take the next one.
- You have side effects from your medicine that bother you.
How Does Deep Brain Stimulation Work?
Your brain cells need to "talk" to each other for your body to move smoothly. In Parkinson's disease, the signals between brain cells aren't working right.
DBS is similar to a pacemaker that controls the heart rhythm. It sends electrical impulses to the brain to stop the faulty signals that cause Parkinson's symptoms.
What to Expect During Surgery
You'll get DBS surgery in two parts. During the first part, the surgeon puts in the electrodes. You'll be awake while this is going on, but you'll get medicine to relax you and prevent pain.
First, your doctor will place a special frame around your head to keep it still. They'll use magnetic resonance imaging (MRI) to map out the areas in your brain where they'll do the operation.
Your surgeon will place electrodes into areas on one or both sides of your brain that control movement. They'll ask you to do certain tasks during the procedure to help them put the electrodes in the right spots.
On the same day or at a later time, you'll have a second surgery to put in a device called an impulse generator. It's battery-operated and sends impulses to the electrodes in your brain.
You will be asleep for this procedure. The surgeon will place the generator under the skin of your upper chest, just below your collarbone. Wires will connect the generator to the electrodes in your brain.
After DBS
A few weeks after the surgery, your doctor will program the generator to send impulses to your brain. It can take a few months to get the settings just right to control your symptoms.
You'll have a remote controller so that you can turn the generator on and off. Some devices will let you make small adjustments to the impulses at home. But you'll have to go back to your doctor's office to make any big changes to the programming.
What Are the Risks?
Although DBS surgery is generally safe, it can cause side effects in a small number of people.
Risks from the surgery to put in the device include problems like:
- Bleeding in the brain
- Infection
- Stroke
- Seizures
- Breathing problems
- Nausea
- Heart problems
Side effects from using the device include problems with thinking, speech, or movement. You could also have:
- Depression
- Numbness or tingling
- Weakness
- Abnormal feelings
- Muscle spasms
Sometimes a wire can move or the generator can break. If something happens to the device, you'll need another procedure to fix the problem.
The batteries in the generator will eventually need to be replaced. You'll need surgery to have that done. How long the batteries last depends on which type of generator you have and how often you use it.
Outlook
Deep brain stimulation won't cure Parkinson's or reverse the disease, but it could lessen your symptoms. If DBS works well for you, you may be able to cut back on your medicine.
Everyone responds to this procedure in a different way. Ask your doctor what to expect before you have DBS surgery.
