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By Michael Rezak, M.D., Ph.D.,
Director, DBS Program
Central DuPage Hospital, Winfield, IL
Deep Brain Stimulation (DBS) has come a long way since 2002 when it won FDA approval for treating Parkinson’s disease. Since then, some 20,000 such procedures have been performed in the US alone. The integration of state-of-the-art technology into DBS surgery has made the procedure more efficient, safe, accurate, and comfortable for the patient.
Today, DBS is a standard treatment that is considered when an individual’s:
Symptoms are progressing and becoming more difficult to manage with medication, and/or are causing excessive side effects.
Motor fluctuations are beginning to interfere with quality of life.
Candidates undergo a detailed, pre-op evaluation to determine the appropriateness of DBS for them. In our program, this includes a videotaped examination on and off medication, neuropsychological evaluation, and an MRI of the brain. A family conference may be held to discuss results and realistic expectations for improvement resulting from DBS.
Using microelectrode recording equipment and an MRI installed in the operating room assure accurate placement of electrodes within the brain. Targeting the subthalamic nucleus (STN) allows for a 30 - 50% reduction in medications, besides treating bradykinesia, rigidity, and tremor, and improving dyskinesias and motor fluctuations.
Qualifications of ideal
DBS candidate:
No significant cognitive impairment, as measured by formal neuropsychological testing.
A diagnosis of idiopathic PD reinforced by L-dopa responsiveness. DBS is not beneficial in other forms of parkinsonism.
Complications (dyskinesias, motor fluctuations, tremor, bradykinesia, and rigidity) related to dopaminergic therapy that respond well to DBS.
Tremor that does not respond to medications, but other PD symptoms that do.
No tolerance for PD medications, developing side effects even at low doses.
Family support in decision to proceed with DBS. This decreases patients’ stress and lowers risks during recovery.
No significant medical illness.
No symptoms (i.e. gait and balance issues, memory disturbance) unresponsive to dopaminergic medications, as these will not respond to DBS either.
Realistic expectations, shared by family members, of the potential benefits from DBS
Are you a candidate for Deep Brain Stimulation (DBS)?
