Deep Brain Stimulation for Parkinson's and What to Expect from DBS
Parkinson’s disease (PD) is a progressive neurological ailment that causes tremors, rigidity, and difficulty moving and coordinating. While drugs are often useful in treating early symptoms, some individuals eventually require more advanced treatment choices when medications alone are insufficient. One such possibility is Deep Brain Stimulation (DBS), a surgical procedure that has transformed Parkinson’s disease treatment.
This blog by Jaslok Hospital, the best hospital for Parkinson’s disease in Mumbai, will explain what DBS is, how it works, and what to expect before, during, and after surgery.
What is Deep Brain Stimulation?
Deep Brain Stimulation involves inserting electrodes into specific parts of the brain. These electrodes are linked to a tiny device (similar to a pacemaker) inserted beneath the skin in the chest. The gadget delivers electrical impulses to the brain to help regulate the aberrant activity that produces Parkinson’s symptoms.
DBS cannot cure Parkinson’s disease or stop its progression, but it can considerably reduce symptoms, enhance quality of life, and minimize the need for drugs. It is particularly beneficial for those whose symptoms are not well controlled by medicines.
Who is a Candidate for DBS?
Not all Parkinson’s patients qualify for DBS.
- Candidates typically have experienced Parkinson’s disease for at least four years.
- Experience motor symptoms (tremors, stiffness, and slowness) that have a major impact on their quality of life.
- Have a positive response to levodopa (a typical Parkinson’s disease drug), but may encounter adverse effects or “off” periods during which the medication is less effective.
- Do not have serious cognitive impairment or untreated mental illnesses such as sadness or anxiety.
Before deciding whether DBS is appropriate, a full assessment is required, which generally includes a team of neurosurgeons and psychologists.
The Benefits and Risks of DBS
Before entering into the stages of DBS surgery, it is critical to consider the benefits and hazards.
Benefits of DBS
- Reduction in motor symptoms: DBS is extremely effective at reducing tremors, stiffness, and dyskinesias (involuntary movements) associated with long-term treatment.
- Improved quality of life: Many patients report increased independence and a return to hobbies they had previously abandoned.
- Medication dosage reduction: DBS allows many patients to lessen their reliance on drugs, reducing side effects like nausea, hallucinations, and sleep disruptions.
Risk of DBS
- Surgical risks: As with any brain surgery, there is a chance of infection, hemorrhage, or stroke. However, technological developments have greatly minimized these risks.
- Device Complications: The DBS system may malfunction, requiring additional surgery to repair or replace components.
- Cognitive or emotional effects: In some situations, DBS might cause changes in mood, cognition, or speech, therefore patient monitoring is essential both before and after the treatment.
What to Expect Before Surgery?
The path to DBS surgery is multi-step, requiring examinations, testing, and planning.
Pre-Surgical Evaluation
Before the surgery, a thorough pre-surgical evaluation will be performed, which often includes:
- Neurological Examination: Your neurologist will evaluate the severity of your Parkinson’s symptoms, how well you respond to the treatment, and how motor fluctuations affect your everyday life.
- Brain Imaging: MRI or CT scans can assist determine which parts of your brain to target during surgery.
- Neuropsychological testing: A psychologist or psychiatrist may assess cognitive performance, emotional well-being, and psychiatric history to rule out problems that could deteriorate with DBS.
- Medication Trial: You may be requested to temporarily discontinue your medications prior to specific assessments to determine the possible benefits of DBS.
Surgical Planning
If you are considered a good candidate, the following step is surgical planning. The neurosurgeon will use brain imaging tools to determine the exact spot for electrode placement. Advanced technology, like as intraoperative MRI and microelectrode recording, aids in precise targeting.
What to Expect During Surgery
The DBS technique is often divided into two stages: brain surgery to install the electrodes and chest surgery to implant the neurostimulator (pulse generator).
Stage 1: Electrode Implantation
- Awake Surgery: In most circumstances, brain surgery takes place while the patient is awake. This enables the surgical team to monitor symptoms in real time when the electrodes are inserted. Local anesthesia is utilized to numb the scalp, and sedation is administered to make the patient comfortable.
- Electrode placement: entails drilling small holes in the skull and inserting electrodes into specific parts of the brain, most commonly the subthalamic nucleus (STN) or globus pallidus internus (GPi), which are related with motor function. During this procedure, the patient is frequently requested to make motions to check that the electrode is properly placed.
- Testing: After the electrodes have been positioned, electrical stimulation is used to ensure that the correct area of the brain is being targeted. Adjustments may be made to improve the results.
Stage 2: Pulse Generator Implantation
- Under General Anesthesia: The second stage, which usually occurs a week or two later, is implanting the pulse generator in the chest. This is performed under general anaesthesia. A small incision is made beneath the collarbone, and the pulse generator is attached to the electrodes by an extension line that extends beneath the skin from the head to the chest.
- Programming the Device: After recovery, doctors program the DBS device to send electrical impulses according to the patient’s demands. This method may require several visits to fine-tune the settings.
What to Expect After Surgery?
Recovery following DBS surgery varies, however most patients can return home within a few days of each stage of the procedure. However, healing and adjusting to the new system can take weeks or months.
Short-Term Recovery
- Post-Surgical Monitoring: Following surgery, you will be closely examined for any acute issues, such as infection, bleeding, and swelling. Mild discomfort at the incision sites and headaches are normal, but usually go away soon.
- Gradual Symptom Improvement: Although initial improvements in symptoms may be visible quickly after surgery, it can take several months to reap the full advantages of DBS as the device is fine-tuned.
- Physical Therapy: Following surgery, many patients receive physical therapy to help them regain motor function and coordination.
Long-Term Management
- Follow-up Appointments: Regular follow-up appointments with your neurologist are required to assess progress and adjust the DBS settings as your symptoms change.
- Medication Adjustments: You may be able to progressively lower your Parkinson’s medications, however some individuals will still require low doses.
- Battery Replacement: The pulse generator’s battery normally lasts 3-5 years before needing to be replaced via a simple surgery. Rechargeable pulse generators will last longer.
Potential Complications
While DBS can significantly reduce symptom severity, it is not without risks. Some patients may suffer the following adverse effects:
- Speech difficulties: Speech pattern changes, such as slurred speech or trouble articulating, can develop.
- Balance and gait issues: Despite improvements in motor symptoms, some patients have difficulty walking and maintaining balance.
- Mood and behavior changes: In rare situations, DBS can result in mood swings, depression, or impulsive conduct.
Deep brain stimulation is a life-changing treatment for many Parkinson’s patients. It provides respite from debilitating symptoms and can improve quality of life when drugs are no longer effective. However, it is not a cure, and careful deliberation is required to decide whether it is the best alternative. Patients who understand what to expect before, during, and after surgery can make more educated decisions and plan for the next stages in Parkinson’s disease management.
If you or a loved one is considering DBS for Parkinson’s, you should have open discussions with your healthcare team, ask questions, and balance the pros and dangers. With proper direction and care, DBS can provide a new lease on life for people suffering from Parkinson’s disease.
At Jaslok Hospital, the best hospital for Parkinson’s disease in Mumbai, our skilled team of neurologists and neurosurgeons is committed to offering breakthrough therapies such as Deep Brain Stimulation to help Parkinson’s sufferers regain control of their life. Jaslok Hospital is dedicated to providing the best neurological care possible by combining cutting-edge technology and individualized care.
