One of the newer treatments for Parkinsons disease is a surgical procedure that implants a thin, metal electrode into one of several spots in the brain and attaches it to a computerized pulse generator similar to a heart pacemaker. The treatment is called Deep Brain Stimulation, or DBS for short, and its one of the most promising treatments for long term control of the worst symptoms of Parkinsons. According to a recent study that followed 79 patients whod had bilateral (both sides) DBS performed for two years after the surgery, DBS

improves the patients quality of life, and these improvements are maintained in the long term. In addition, improvements in quality of life are strongly related to improvements in functional ability, particularly that affected by bradykinesia.

In addition, researchers found that the patients who participated were taking lower levels of medication (or none), but showed significant improvement in the areas of tremors, rigidity and balance and control.

The science behind DBS is that the electrical stimulation on certain areas of the brain can temporarily reverse the effects of the loss of dopamine by providing a similar effect. Rather than focusing on the area of the brain that produces dopamine, DBS stimulates secondary areas of the brain that are affected by the dopamine.

All parts of the system are internal. None of the wires come through the skin, so no one will be able to tell that youre wearing an electronic stimulator.

How does a doctor decide if Im a good candidate for DBS?

The decision to try DBS is one that should be made by your doctor after an assessment of your symptoms and your general health. Studies have shown that those who benefit the most from DBS are those who are in good general health, maintain normal memory and cognitive functioning, and are still responding (at least some of the time) to treatment with levodopa.

What are the benefits of DBS for Parkinsons disease?

DBS seems to curb the same symptoms of Parkinsons disease that L-dopa does. Symptoms that dont respond to L-dopa dont usually respond to DBS. The main benefit of DBS is that it makes movements during the off state of medication more like those during the on state.

It also seems to reduce the dyskinesia associated with long term treatment with L-dopa. So far, theres no evidence that DBS slows the progression of the actual disease or halts the dying of the dopamine producing cells in the brain.

What are the risks of DBS?

The major risk associated with DBS is bleeding in the brain, which may produce a stroke. Theres a 2% risk of that happening, and if it does, it generally happens within the first couple of hours after surgery. In addition, theres a 4% risk of infection in the brain after the implantation of the electrodes, which will necessitate removal of the entire system. It can usually be replaced after the infection subsides.

Does insurance cover DBS?

Medicare now covers DBS. Private insurance carriers may vary. Its best to make sure of your coverage before entering the hospital.

Image: Laurentiu Huianu, Norfolk and Norwich University Hospitals NHSFT. Wellcome Images

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