Wellness Series Summary – Deep Brain Stimulation Q&A

Speakers: Sudeshna Bose, MD and Eric Rhoden, PT, DPT

 

What is Deep Brain Stimulation (DBS)?

• Surgical option for the treatment of Parkinson’s disease that works like a pacemaker for the brain
• Most effectively treats tremor but can also treat rigidity and bradykinesia especially in the periphery
• Not effective at treating midline symptoms such as posture, balance, speech, swallowing, and constipation

What occurs during DBS surgery?

• Leads are placed into the brain either unilaterally or bilaterally
• The voltage is revved up during surgery and you may be asked to speak or perform movements with your hands to make sure there are no side effects

What type of preparation is needed for DBS?

• On/off testing
  • Good candidates perform ~30% better with testing during on state versus off state
  • Those who respond well to medication typically respond well to DBS
  • Can also help determine appropriate location for placement and what kind of improvement may be expected
• Neuropsychology/cognitive testing
• Meeting with surgeon

What takes place after the surgery?

• Usually requires an overnight stay
• Battery is typically placed 1-2 weeks later
• Approximately 1-3 weeks later, a screening is performed to determine which contacts should be stimulated for optimal programming
• Programming can take days to weeks to months as the brain heals
• Some programming appointments allow you to come in on your “on” state, but most ask you to come in on your “off” state

Where is the battery placed?

• The battery is most commonly placed over the chest
• It can also be placed in the abdomen

How and when is the battery replaced?

• Surgical procedure that occurs every 4-6 years
• Battery cannot guarantee voltage as it gets low and you may see symptoms return

When should someone consider DBS as a treatment option?

• If you are a good candidate, DBS is recommended earlier rather than later for the most benefit

What are the possible negative side effects?

• Can negatively affect cognition and speech (especially when done bilaterally)
• Unrealistic expectations leading to disappointment

Why would DBS be performed bilaterally instead of unilaterally?

• If PD symptoms are on both sides of the body, DBS is typically performed bilaterally
• If PD symptoms are only on one side of the body, DBS is typically performed unilaterally
• If PD symptoms are on both sides but minor on one side, it may be performed unilaterally

What percentage of people with DBS cannot tolerate it or need to have it removed?

• If there is an infection, then the DBS needs to be removed
• If the stimulation is causing side effects rather than helping, DBS may be turned off

If there is an infection and the DBS is removed, can you have it reinstalled at a later date?

• DBS can be reinstalled, but it will need to be placed in a different tract after the infection has cleared.

Does insurance cover DBS?

Can I stop taking my PD medications with DBS?

• Medication can usually be reduced by 30-50% with DBS but will not eliminate PD medications

How often does programming occur and why?

• Every 3-6 months on average
• Due to disease progression
• To check the battery life
• Improve current programming

Can I adjust my own programming?

• You may be allowed to adjust your programming within certain parameters
• Some clinics do not allow any adjustments
• You may have different groups of programming to target different symptoms
  • A group for tremor control and another group for walking