Surgical Relief for Neurological Disorders

When medication isn’t enough to control symptoms of certain neurological disorders, deep brain stimulation (DBS) can be a viable option for symptom relief. For those who experience tremors, stiffness, slowness and involuntary movements, performance of daily tasks can be difficult or frustrating.

While DBS doesn’t provide a cure, it can be used to significantly control symptoms for a number of conditions for many years. For example, DBS is the most commonly performed surgical treatment for Parkinson’s disease and can help reduce symptoms such as tremor, stiffness and slowed movement while allowing a reduction in medication. Often, the reduction in medication improves many side effects.

Conditions Treated With DBS

• Parkinson’s disease
• Dystonia (involuntary muscle contractions)
• Essential tremor
• Obsessive compulsive disorder

How DBS Works

DBS is a surgical procedure that delivers high-frequency electrical stimulation to precise areas of the brain. This is done by implanting a thin wire with electrodes at the tip. The electrodes are precisely placed into a brain site that carries the abnormal signals producing the symptoms. High frequency stimulation will alter these abnormal signals, thereby leading to symptom improvement. The location of electrode placement varies based on the illness being treated.

Prior to the procedure, a pre-operative evaluation is performed in order to maximize the success of DBS surgery. The evaluation may include brain MRI scan, neuropsychological testing, videotaped evaluation of movement both on and off medication, and others if indicated.

The precise placement of the electrodes is achieved both by MRI measurement as well as intraoperative microelectrode mapping. Once the electrodes are placed, the wire is connected to the neurostimulator power supply (a battery-operated generator), which is placed under the skin near the collarbone. The system, often called a brain pacemaker, regulates the abnormal signals resulting from the disease process.

Once the electrodes and the impulse generator are securely in place, the electrodes send electrical impulses that help normalize abnormal impulses. In other words, it will help block faulty signals within the brain that cause tremors or other movement symptoms to occur. No healthy tissue is destroyed with this procedure.

Who Should Consider DBS

DBS is an option to consider if symptoms can’t be adequately controlled by medication, are progressing, are becoming more difficult to manage, and are impacting quality of life. You may also want to consult your physician to see if DBS is the right treatment for you if:

• Medications no longer work as quickly or effectively as they used to.
• You have to take medications multiple times per day.
• You are taking progressively higher doses of medication for the same effect.
• Medications required to control symptoms result in unacceptable side effects such as hallucinations and/or dyskinesias.
• The side effects of medication have become intolerable.

Life After DBS

Everyone responds to DBS differently. For most, results are noticed shortly after the initial programming of the DBS. However, it could take several visits to adjust the settings for maximal benefit. Your physician will work with you to adjust the parameter settings in order to find the optimal symptom control without side effects. These can continually be updated as your symptoms change over time.

Since it is not a cure, medication may still be required, but those with DBS often are able to reduce medication dosage. It should be noted that DBS will not alter the progression of conditions like Parkinson’s disease or essential tremor.

Consult your neurologist to find the treatment right for you.

– Michael Rezak, MD, PhD, Northwestern Medicine Regional Medical Group, Neurology