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 and the cells in other brain areas, that don't function properly without the input from the substantia nigra

What are the Symptoms of Parkinson's?
Symptoms include tremor (shaking) at rest, rigidity (stiffness) of the limbs, slowness of movements (bradykinesia), difficulty walking with loss of balance, and a soft voice, sometimes with some slurring of the speech. Occasionally, Parkinson's can also cause sleep disturbances, dementia, depression, personality changes, dizziness, and bladder and sexual dysfunction. Symptoms generally get slowly worse over time.

What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a procedure used to treat certain symptoms of Parkinson's disease. It is designed to help patients with their tremor, and slowed movements, among other symptoms. DBS uses electrical currents to "jam" abnormal brain signals.

DBS involves the implantation of a battery-operated pacemaker-like device (implanted pulse generator) under the collarbone. Attached to this device is a wire, which runs under the skin along the length of the neck up to the scalp. The wire connects to an electrode, which is inserted into the target area deep inside the brain through a small hole in the skull. Once in place, electrical impulses are sent from the implanted pulse generator to the tip of the electrode, these impulses interfere with the abnormal electrical signals that cause tremor and other symptoms of Parkinson's disease. A number of symptoms typically respond very favorably to DBS, while other symptoms (e.g., problems with balance) do not tend to get much better.

Aside from Parkinson's disease, DBS surgery may also be performed for patients with Essential tremor (ET), refractory to standard medical treatment, and for patients with severe dystonia. The brain areas targeted for those diseases are different from the area targeted for Parkinson's disease.

How is the Neurotransmitter Implanted? Will I Need to be Hospitalized?
The DBS system 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 in the brain, which has been pre-selected by MRI. This process is done in part while the patient is awake for test stimulation of the electrode, to confirm proper placement during the surgery. After this electrode placement, patients stay in the hospital for observation, typically for one night. About 2 weeks later, patients return for placement of the battery-operated pulse generator in the chest area. During this 2nd procedure, the wire from the electrode and the wire from the pulse generator are connected with each other. This procedure is typically a one-day stay, similar to the placement of a cardiac pacemaker.

What Other Treatments Exist for Parkinson's?
Several effective medications are available for Parkinson's disease, including carbidopa/levodopa, dopamine agonists, and others. As the disease progresses, these medications often don't provide uninterrupted benefit any longer; rather, patients typically experience wearing off, on- and off-periods, and fidgety-like involuntary movements called dyskinesias.

What are the Benefits of Deep Brain Stimulation?
DBS provides good benefit for certain symptoms (including slowness, stiffness, and tremor). Importantly, fluctuations (like wearing off and on-off-phenomena) usually improve a lot in response to DBS, since the stimulation goes on in an uninterrupted fashion. Although patients typically still need to take medication after undergoing DBS, they can often reduce their dosages so much that side effects (such as dyskinesias) improve substantially. Other symptoms, including balance problems, falls, and often speech impairment, may not respond favorably to DBS surgery.

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 pulse generator device can easily be re-programmed. Further surgery is not needed until the battery in the chest is replaced, typically 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 electrode 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. The ideal candidate will have motor fluctuations, gait impairment without frequent falls, and minimal or no cognitive impairment, among other criteria and considerations.

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.

Our dedicated DBS team consists of highly experienced experts from our Departments of Neurology and Neurosurgery. Every candidate for surgical intervention is examined very carefully, including comprehensive psychiatric and neuropsychological evaluations. The team also guides and follows each patient through the 2 hospitalizations and provides frequent and detailed follow-up care in the weeks, months and years after the surgery. We have many years of experience, and excellent results in DBS treatment for Parkinson's disease, Essential tremor, and dystonia.

For More Information
Attend one of the free DBS educational seminars, presented by the Maryland Parkinson's Disease and Movement Disorders Center.

  • June 11, 2015
  • July 13, 2015
  • August 10, 2015
  • September 17, 2015
  • October 12, 2015
  • November 12, 2015
  • December 13, 2015

Please register for the seminar by calling 1-800-492-5538

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).

         
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