What is Parkinson's Disease?

Parkinson’s disease is a long-term condition that affects your nervous system and the areas of your body that are controlled by nerves. Symptoms usually begin with a barely perceptible tremor in one hand. These tremors are common in Parkinson’s, but the disorder can also cause stiffness or slow movement.

Early signs of Parkinson’s include your face showing little or no expression, your arms not swinging when you walk, and your speech becoming slurred or soft. As your condition progresses, Parkinson’s symptoms become worse.

There is no cure for Parkinson’s disease, but medications may improve symptoms. Your health care provider may also recommend surgery to treat certain areas of your brain to improve symptoms.

Treatment

There's no cure for Parkinson's, but medications can help manage the symptoms, sometimes even leading to a dramatic improvement. In some more severe cases, surgery could be a possibility. Your doctor or nurse may also suggest making changes to your lifestyle, like getting regular aerobic exercise. Physical therapy that emphasizes balance and stretching can also help with speech problems, so it's important to talk to a speech-language specialist.

Surgical procedures

Deep brain stimulation

Deep brain stimulation (DBS) is a surgical procedure in which electrodes are inserted into a specific area of the brain. These electrodes connect to a generator that is implanted in the chest, close to the collarbone. This generator sends electrical impulses to the brain, which may reduce the symptoms of Parkinson’s disease. Your health care team may change your settings as needed to treat your condition, and surgery may involve risks, such as infection, stroke or brain haemorrhage. Some patients experience problems with their DBS system, or complications due to stimulation, and a member of your healthcare team may need to change or replace certain parts of your system.

The most common use of DBS is for people with advanced Parkinson’s who have an unstable response to levodopa and are unable to control their dyskinesia or Parkinson’s symptoms. DBS is effective in stabilizing medicine fluctuations, reducing or halting involuntary movements, reducing tremor, reducing rigidity, and improving movements. However, DBS is not effective in treating problems that don’t respond well to levodopa, such as dyskinesia and do not improve with medication adjustments. DBS is not helpful for problems that do not respond to levodopa

What is Deep Brain Stimulation?

Deep brain stimulation involves the implantation of electrodes into the brain. These electrodes generate electrical impulses that alter brain activity in order to treat specific medical conditions. These electrical impulses can also interact with cells and chemicals in the brain that lead to medical conditions.

Deep brain stimulation is performed using a device that is similar to a pacemaker. This device is placed under your upper chest. The device is connected to your brain via a wire that runs under your skin.​

Why it's done

Deep brain stimulation is used to treat many conditions which include:

• Parkinson’s disease,

• Essential tremor,

• Dystonia,

• Meige syndrome,

• Epilepsy,

• Tourette’s syndrome

• Obsessive-compulsive disorder

  
  
  
  

Deep brain stimulation is also being investigated as a treatment for:

• Chronic pain

• Chorea, such as Huntington's disease.

• Cluster headache

• Dementia

• Depression

• Addiction

• Obesity

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How you prepare

The first step is to consider the pros and cons of the surgery

Deep brain stimulation is an invasive and potentially dangerous procedure. It is important to discuss the potential risks and benefits of the procedure with your healthcare provider.

The second step is to prepare for the surgery

You will likely need to undergo medical tests to ensure that the procedure is safe and suitable for you. Additionally, you may need to undergo brain imaging studies, including an MRI, prior to the surgery. Brain imaging studies help map the regions of the brain where electrodes are implanted.

What you can expect

During the surgery

Brain Surgery: Your care team will fit your head frame, also known as a stereotactic (or stereoselective) head frame, to your head during brain surgery. This frame will keep your head still throughout the procedure. Neuroimaging, like brain MRI or CT, will map your brain. Neuroimaging will point the electrodes to the correct area in your brain.

Most of the time, the electrodes will be placed while you are awake. This is to ensure that the effects of stimulation are fully evaluated. If you are awake for brain surgery, you will likely receive a local anesthetic that will numb your scalp prior to the procedure. An anesthetic will not be needed in your brain because the brain does not have pain receptors. For some people, surgery may be performed using a medicine known as general anesthesia, which puts you to sleep.

During brain surgery, your surgeon will implant a thin wire lead, with several electrodes at its tips. The lead will be placed into a specific region of your brain. In some cases, two leads will be implanted. In others, two leads may be implanted into your brain. A wire is run under your skin and connected to a device known as a pulse generator, which is implanted in your collarbone.The neurologist and surgeon closely monitor your brain during surgery to ensure electrode placement is correct.

Chest Surgery: During the chest wall surgery in the second part, the surgeon inserts the pulse generator beneath the skin of your chest, close to the collarbone, where the batteries are located. During this procedure, general anesthesia is used to put you to sleep. The wires from your brain electrodes are inserted under the skin and directed to the battery operated pulse generator. Several weeks after your surgery, the pulse generator will be programmed during a follow-up appointment with your health care provider. After it is programmed, it will send continuous electrical impulses to your brain using a remote control. You can turn the generator on or off with a remote control.

After The Surgery:

The pulse generator is activated a few weeks after your surgery, usually in your healthcare professional’s office. It can be programmed remotely using a remote control, and the amount of stimulation is tailored to your condition. Finding the right setting can take up to 4 to 6 months.

The pulse generator may be used 24 hours a day, or you may be instructed to turn it off at night and on again in the morning. Again, this is based on your condition.

You can turn the pulse generator on and off using a remote control you take home. The pulse generator may also be programmed to allow you to make small changes at home, depending on your conditions.

Battery life depends on how often the pulse generator is used and what settings it is set to. Your surgeon will replace the battery during an outpatient procedure.

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Risks

Deep brain stimulation is considered to have a low risk of complications. However, any surgery has a high risk of complications. Brain stimulation can also cause side effects.

Common side effects include:

• Seizure.

• Infection.

• Headache.

• Confusion and trouble concentrating.

• Stroke.

• Hardware complications, such as an eroded lead wire.

• Temporary pain and swelling at the implantation site.