Deep Brain Stimulation for Parkinson's Disease

Deep Brain Stimulation for Parkinson's Disease: A Comprehensive Guide

Understanding Parkinson's Disease

Parkinson's Disease (PD) is a chronic, progressive neurological disorder that primarily affects motor function, due to the degeneration of dopamine-producing neurons in the brain. This leads to a variety of symptoms that can significantly impact daily life. On this page, we will explore Deep Brain Stimulation Surgery for Parkinson's Disease in details.

Symptoms of Parkinson's Disease

Parkinson's Disease presents a variety of motor and non-motor symptoms. However, the most troublesome motor symptoms include:

Motor Symptoms of Parkinson's Disease

Tremors: Involuntary shaking, typically beginning in the hands, often manifesting as a resting tremor initially.

Rigidity: Stiffness and inflexibility in the limbs and trunk. Mostly starts around the wrist joint.

Bradykinesia: Slowness of movement can make simple repetitive tasks, such as opening and closing the hands or tapping the fingers, challenging.

Dyskinesia: Involuntary, erratic movements commonly caused by long-term use of medications like levodopa. Dyskinesia, often associated with Levodopa medications, can cause severe involuntary movements in patients' arms, legs, mouth, or head. These movements are a side effect of Levodopa, and as the dosage increases due to disease progression, these troubling involuntary movements can become more pronounced and frustrating.

Freezing on Gait: Sudden, temporary inability to move while walking. The patients face significant challenges when trying to take the first step. Generally, the patient can start walking normally after taking the first step. However, if they encounter an obstacle like a corner or an item in their path, they may stop abruptly and struggle to resume walking.

Non-Motor Symptoms of Parkinson's Disease

Cognitive Impairment: Many patients experience difficulties with attention, planning, and judgment. Cognitive decline may progress to dementia in the later stages of the disease.

Mood Disorders: Depression and anxiety are common among Parkinson's patients, often resulting from the chemical changes in the brain associated with the disease.

Sleep Disorders: Insomnia, excessive daytime sleepiness, and REM sleep behavior disorder (acting out dreams) are prevalent in Parkinson's Disease.

Autonomic Dysfunction: Issues like constipation, urinary problems, and orthostatic hypotension (a form of low blood pressure that happens when standing up from sitting or lying down) frequently affect patients.

Sensory Complaints: Some patients report pain, numbness, and a decreased sense of smell (anosmia) early in the disease.

Fatigue: Profound tiredness that is not alleviated by rest can significantly impact the quality of life and daily functioning.

What is Deep Brain Stimulation (DBS)?

Deep Brain Stimulation (DBS) is a surgical treatment designed to alleviate these motor symptoms . It involves implanting a device that sends electrical impulses to specific areas of the brain, thereby modulating abnormal neural activity and providing symptom relief. You can find detailed information on following link about Deep Brain Stimulation : What is Deep Brain Stimulation

How Does DBS Work?

Surgical Procedure

The DBS (Deep Brain Stimulation) procedure begins with the precise placement of electrodes in targeted brain regions, usually the subthalamic nucleus (STN) or globus pallidus interna (GPi). This is a critical step, as it requires detailed imaging and mapping to ensure accuracy. You can find detailed information on following link about How is Deep Brain Stimulation (DBS) Surgery Performed? : "How is Deep Brain Stimulation (DBS) Surgery Performed?"

Target Selection: STN or GPi

The choice of target in Deep Brain Stimulation (DBS) surgery—subthalamic nucleus (STN) or globus pallidus interna (GPi)—is a pivotal decision that significantly impacts the outcomes for patients with Parkinson's Disease. STN is often selected for its ability to improve a wide range of motor symptoms, including tremors, rigidity, and bradykinesia. STN is more powerful and acts faster, especially on tremors, compared to Gpi. Targeting the STN can also lead to a reduction in medication requirements post-surgery, which is beneficial for managing medication-induced side effects such as dyskinesia. But unfortunately, targeting the STN can induce dyskinesia itself. If a patient develops dyskinesia after STN stimulation, our only recourse is to reduce medication. In cases who has a Levodopa induced Dyskinesia, the STN can cause, trigger, or exacerbate the dyskinesia.

Conversely, GPi targeting is particularly effective in controlling dyskinesia and may be preferred for patients whose primary issue is medication-induced involuntary movements. GPi stimulation also has a stabilizing effect on motor fluctuations. Additionally, the Gpi can be safer than the STN, particularly for patients with balance and consciousness issues, as well as for elderly individuals.

Both targets have demonstrated significant efficacy in clinical trials, and the choice between STN and GPi is typically made based on individual patient profiles, symptomatology, and potential benefits and risks discussed in a multidisciplinary team setting.

Following the electrode implantation, the implantation of a pulse generator, which is similar to a pacemaker, is performed under the skin of the chest. This device is connected to the electrodes in the brain via thin, insulated wires that tunnel under the skin. The pulse generator delivers electrical impulses to modulate brain activity and alleviate symptoms.

During the electrode implantation, the surgeon may also perform microelectrode recordings and stimulation tests. These tests involve temporarily stimulating the brain region to observe the effects and ensure the correct electrode placement for optimal symptom relief. This intricate process not only aims to improve the patient’s symptoms but also enhances their overall quality of life by offering more consistent control over their condition.

Technology Involved

The pulse generator sends continuous electrical impulses to the brain, interfering with the irregular activity that causes PD symptoms. These impulses can be adjusted and programmed externally to optimize therapeutic effects.

Benefits of DBS in Managing Parkinson's Symptoms

DBS offers numerous benefits for managing the debilitating motor symptoms of Parkinson's Disease, including:

Tremor Suppression: Significant reduction or elimination of tremors. The STN target is particularly effective for tremors, delivering faster and more pronounced results.

Dyskinesia Suppression: Decreased involuntary movements especially by Gpi stimulation itself or medication reduction.

Stability in Motor Function: Reduced fluctuations in motor symptoms can lead to a more consistent and manageable daily routine for individuals, improving their overall quality of life and allowing them to engage more confidently in various activities.

Medication Reduction: Potential reduction in medication dosage, thereby minimizing side effects.

Which Symptoms Will Improve by Deep Brain Stimulation Surgery on Parkinson's Disease

Effects of Deep Brain Stimulation Surgery on Motor Symptoms of Parkinson's Disease

Deep Brain Stimulation (DBS) surgery offers significant improvement for several motor symptoms associated with Parkinson's Disease. Most notably, it effectively reduces tremors, which are among the most debilitating symptoms for many patients. DBS also alleviates rigidity and bradykinesia, thereby improving muscle stiffness and slowness of movement. Additionally, the surgery helps in controlling dyskinesia, particularly those induced by long-term Levodopa use, and contributes to greater stability in motor function, decreasing the unpredictability of motor fluctuations. Furthermore, many patients experience a reduction in the overall required dosage of Parkinson’s medication post-surgery, thereby minimizing the associated side effects. This comprehensive symptom control allows for an enhanced quality of life and more consistent engagement in daily activities for those affected by Parkinson’s Disease.

Effects of Deep Brain Stimulation Surgery on Non-Motor Symptoms of Parkinson's Disease

While Deep Brain Stimulation (DBS) surgery is primarily known for its effectiveness in mitigating the motor symptoms of Parkinson's Disease, it also exerts a significant impact on non-motor symptoms, which are often equally debilitating. Patients frequently report improvements in sleep quality and reductions in fatigue, which contribute to overall well-being. Additionally, DBS has been shown to help alleviate certain types of pain and sensory dysfunction that can accompany Parkinson's. Cognitive function may also benefit, particularly in terms of increased alertness and enhanced cognitive flexibility. Emotional and psychological symptoms, such as anxiety and depression, can see marked improvements post-surgery, positively influencing a patient's mental health. This holistic effect on both motor and non-motor symptoms underscores the comprehensive benefits of DBS, reinforcing its role as a pivotal treatment option in the multidisciplinary management of Parkinson's Disease.

Eligibility Criteria for DBS

Not all patients with Parkinson's Disease are candidates for DBS. Eligibility typically depends on:

Stage of Parkinson's: Generally more effective in advanced stages of the condition, where medications no longer adequately control symptoms and patients experience significant deterioration in their quality of life. This approach often becomes necessary to provide better management of the disease and improve overall well-being.

Overall Health: Patients must be in good overall health to tolerate the surgical procedure. All patients must be evaluated by an anesthesiologist to ensure they are suitable for surgery. If a patient has any chronic illnesses, we consult with specialized professors before proceeding with the surgery.

Levodopa Challenge Test: Demonstrates a positive response to levodopa, indicating potential responsiveness to Deep Brain Stimulation (DBS). This suggests that the patient may benefit from advanced therapeutic interventions to manage their symptoms more effectively. In general, symptoms that respond to Levodopa also respond to Deep Brain Stimulation (DBS) surgery, with the exception of tremors. Tremors, however, respond very well to successful DBS surgery, even if they do not respond to medication. In most cases, the medication has little effect on reducing tremors.

Age: DBS (Deep Brain Stimulation) can be performed on patients of any age, offering potential therapeutic benefits for various neurological conditions. However, the risks and benefits must be carefully weighed for older individuals due to factors such as overall health, the presence of comorbidities, and potential complications from surgery. Thorough evaluation and consultation with a medical specialist are essential to determine the suitability of DBS for elderly patients.

Which Parkinson's Disease patients are suitable candidates for DBS surgery?

The best candidates for Deep Brain Stimulation (DBS) in Parkinson's Disease are those who meet specific clinical criteria, ensuring they derive the maximum benefit from the procedure. Ideally, candidates should have a confirmed diagnosis of idiopathic Parkinson's Disease with clear motor symptoms such as tremor, rigidity, and bradykinesia. They should also have fluctuating responses to medication, experiencing significant "on" and "off" periods despite optimized pharmacotherapy. Patients with Dyskinesia can be considered good candidates if the target will be the Gpi, especially if the neurosurgeon has extensive experience in targeting the Gpi. DBS candidates typically are those whose symptoms are inadequately controlled by medication, negatively impacting their daily activities and quality of life.

Furthermore, patients should demonstrate a good response to the Levodopa challenge test, as this indicates the likelihood of positive outcomes from DBS surgery, particularly for symptoms other than tremors. Cognitive function and psychiatric stability are also crucial; candidates should not have significant cognitive impairment or untreated psychiatric disorders, as these conditions can be exacerbated by the surgery.

While there is no strict upper age limit, younger patients often experience better outcomes due to fewer age-related comorbidities. However, elderly patients in good overall health may still be considered, provided a comprehensive evaluation is conducted to assess surgical risks. Ultimately, a multidisciplinary team of neurologists, neurosurgeons, and other specialists should evaluate each potential candidate to personalize treatment plans and optimize surgical outcomes.

Hospital Stay and Recovery

Patients undergoing DBS typically stay in the hospital for about 2-3 after the surgery days. The initial recovery period involves monitoring for any complications and ensuring the proper functioning of the implanted device.

Postoperative Follow-Up and Programming

Postoperative care includes regular follow-up visits to adjust and fine-tune the DBS settings. This optimization process is crucial for achieving the best possible symptom control and is generally carried out by a neurologist specializing in movement disorders.

Additionally, we provide daily walking rehabilitation for patients throughout their stay, with a minimum duration of five days.

Importance of Post-Surgery Walking Rehabilitation

As you are aware, patients with Parkinson's Disease often experience significant walking difficulties over many years. Following surgery, these individuals require dedicated walking rehabilitation to regain their mobility. It is for this reason that we offer comprehensive postoperative walking exercises and rehabilitation services to all our patients. This critical step not only fosters their independence but also reconnects them to their daily lives, enhancing their overall sense of well-being. These rehabilitative measures are a cornerstone of our treatment plan, ensuring that patients receive the support they need to achieve the maximum benefits from their DBS surgery.

Success Rates and Long-Term Outcomes

DBS has shown promising success rates, with many patients experiencing significant improvements in motor function. Long-term outcomes vary but often include sustained symptom relief and improved quality of life.

Comparison with Other Treatments

Compared with other treatments such as medication and physical therapy, DBS offers the advantage of reducing motor symptoms without the side effects associated with long-term medication use. It is often considered when medications become less effective or cause significant side effects, and it can alleviate medication side effects such as dyskinesia.

Seeking Consultation and Treatment

If you are considering DBS, it is essential to consult with a medical professional specializing in Parkinson's Disease and movement disorders. Centers of excellence in cities like Istanbul, Turkey, offer comprehensive evaluation and treatment options.

Frequently Asked Questions (FAQs)

What is the primary purpose of DBS?

DBS aims to alleviate motor symptoms of Parkinson's Disease and improve the patient's quality of life.

Can DBS cure Parkinson's Disease?

No, DBS does not cure Parkinson's Disease but significantly manages its symptoms.

For further information and to explore whether Deep Brain Stimulation is the right treatment for you, please contact our specialists on WP at +90 530 923 39 91

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