Deep Brain Stimulation
What is Parkinson's Disease?
Parkinson's disease is a neurological disorder that erodes a person's control over their movements and speech. Over 1 million Americans suffer from this slowly progressive, debilitating disease.
Although scientists don't know what causes Parkinson's, they do know that it affects the brain's ability to make a chemical called dopamine. When nerve cells die off in the substantia nigra -- the area of the brain that controls movement -- dopamine levels plummet.
Dopamine helps the brain's neurons transmit signals to each other. The less dopamine there is, the less communication there is between the cells in the substantia nigra.
What are the Symptoms of Parkinson's?
Symptoms include tremors or shaking at rest, a loss of balance, rigidity of the limbs, a slowed walking pace and a soft, sometimes difficult-to-understand speaking voice. Occasionally, Parkinson's can also cause sleep disturbances, dementia, depression, personality changes and sexual dysfunction. Symptoms generally get worse over time.
What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a procedure used to treat Parkinson's patients. It is designed to help them with their tremors, slowed movement and walking problems. DBS uses electrical currents to "jam" abnormal brain signals.
DBS involves the implantation of a battery-operated neurotransmitter under the collarbone. Attached to this device is a pacemaker-like wire with an electrode at the tip. This wire is inserted just under the skin and led along the length of the neck up to the scalp, where it is placed through a small hole in the skull. The electrode tip is implanted in the target brain center.
Once in place, electrical impulses are sent from the neurotransmitter up along the wire to the brain. These impulses interfere with and block the electrical signals that cause tremors and other symptoms. Studies have shown that DBS significantly reduces tremors and other movement-interfering symptoms in about two-thirds of all Parkinson's patients.
How is the Neurotransmitter Implanted? Will I Need to be Hospitalized?
The neurotransmitter is usually implanted in two stages. In the first stage the electrode is guided through the small hole in the skull to the target location that has been pre-selected by MRI. This process is done in part while the patient is awake during test stimulation of the electrode, and patients then stay overnight in the hospital. Patients return for placement of the battery-operated neurotransmitter in the chest, and hook-up to the brain electrode, This procedure is a one-day stay, very much like the placement of a heart pacemaker.
What Other Treatments Exist for Parkinson's?
Several effective medications are available for Parkinson's disease. Deep brain stimulation is most suited for patients who have tremor and other difficulties in movement where the medications are unpredictable, inadequate or have significant side effects.
What are the Benefits of Deep Brain Stimulation?
Patients who have undergone DBS usually have consistently improved relief of movement-related symptoms, including tremor. Although patients still need to take medication after undergoing DBS, they can often reduce their dosages so much that side effects such as involuntary movements called dyskinesias improve substantially.
Unlike older types of surgery for Parkinson's disease, DBS does not involve intentional destruction of brain tissue. The jamming signal from DBS is adjusted as an outpatient to provide the patients with the optimal symptom relief. Also, as the patient's condition changes, the neurotransmitter device can be easily readjusted. Further surgery is not needed until the battery in the chest is replaced three to five years later.
What are the Risks of Deep Brain Stimulation?
DBS, like all forms of brain surgery, has a small risk of infection or bleeding. Computer-guided brain imaging is used to reduce the risk of bleeding when the wire is inserted into the brain. Rarely, significant bleeding into the brain can occur with stroke-like signs such a weakness on one side of the body. Some patients also experience short-term confusion.
Who Are Good Candidates for Deep Brain Stimulation?
DBS is used only for patients with at least moderately severe Parkinson's, who aren't getting adequate control of their symptoms with medications.
Why Should Parkinson's Patients Come to the University of Maryland Medical Center for Deep Brain Stimulation?
The University of Maryland Parkinson's Disease and Movement Disorders Center offers a comprehensive management and treatment approach for patients and their families found at only a handful of Centers across the country.
The UM Departments of Neurology and Neurosurgery carefully examine candidates for surgical consideration and involve a dedicated team of experts to care for patients from the initial evaluation to follow-up visits. The DBS team of seasoned neurosurgeons and neurologists have helped pioneer treatment.
For More Information
Attend a free deep brain stimulation educational seminar, presented by the Maryland Parkinson's Disease and Movement Disorders Center. Check back for more details soon.
For more information about Deep Brain Stimulation, please contact Sharon Powell, R.N., M.P.H., DBS coordinator, at 410-328-7797
For more information about the University of Maryland Departments of Neurology and Neurosurgery, or to make an appointment, call the University Physicians Consultation and Referral Service at 1-800-492-5538 (patients) or 1-800-373-4111 (physicians).
This page was last updated: December 3, 2013