Deep brain stimulation - Parkinson's surgery
Deep brain stimulation
(DBS) is a form of surgery that is used to treat some of the
symptoms of Parkinson's.
Deep brain stimulation is not suitable for everyone and is not a
cure for Parkinson's symptoms.
But for some people it may help to alleviate slowness of
movement, stiffness and tremor.
Image above: Hand-held programmer, which allows the patient
to adjust their stimulation on a day-to-day basis
Deep brain stimulation can enable drug dosages to be
substantially lowered, which can lead to a reduction in
drug-related dyskinesias (involuntary movements).
The National Health Service pays for a limited amount of
operations each year. Some private health insurance companies
may provide funding.
The cost of deep brain stimulation varies, but is generally
between £25,000 and £30,000. This includes the system and the
surgery itself, along with inpatient stay and follow-up
assessments.
All surgical procedures have associated risks and this surgery
is not suitable for everyone. The best treatment for most people
with Parkinson's is still drug
treatment.
What does deep brain stimulation involve?
Deep brain stimulation is not suitable for everyone. But for some people it may help to alleviate slowness of movement, stiffness and tremor.
Deep brain stimulation involves the implantation of a wire, with
4 electrodes at its tip, into one of 3 target sites in the
brain:
- the thalamus (this procedure is known as thalamic
stimulation)
- the globus pallidus (this procedure is pallidal
stimulation)
- the subthalamic nucleus (this procedure is subthalamic
stimulation)
The implantation procedure is usually performed under local
anaesthetic with the person awake.
The target site is then stimulated with a small electric current
and the person's response monitored to confirm accurate target
localisation.
The wire is then connected to a small unit called an Implantable
Pulse Generator (IPG). This is implanted - under general
anaesthetic - under the skin in the chest, rather like a
pacemaker.
The wire goes from the top of the scalp, underneath the skin,
and down the side of the neck to the IPG, generally by the
collarbone or sometimes in the abdomen.
Sometimes the wire can get tight so it's important to keep
moving your neck after the operation.
The IPG contains the battery
and electronics to generate the electrical signals for the
stimulation.
The batteries in the Implantable Pulse Generator have a
relatively long life. They only need to be changed every 3 to 5
years.
The IPG is programmed by the clinician using a computer. On a
day-to-day basis, the stimulation can be switched on and off by the
person with Parkinson's using a
hand-held programmer or a magnet.
Image above: Implantable Pulse Generator, implanted under
the skin in the chest
Life after surgery
After surgery people are usually asked to come back after 6
weeks, 3 months, 6 months and 12 months. This will vary among
hospitals and type of procedure.
For those employed before the operation, it is usually possible
to return to work after fully recovering from surgery.
It may be necessary, however, to refrain from driving for 6
months.
The Implantable Pulse Generator may activate airport security
machines so you must inform airline staff and walk around
machines.
Ask to be provided with documentary evidence that you can
present to security staff at airports.
People's experiences of deep brain stimulation
The following accounts are based on true stories. The names in
the first two stories have been withheld to protect
confidentiality.
The future of deep brain stimulation
The long-term outcome of deep brain stimulation so far is very
encouraging.
It could remain the main surgical therapy for Parkinson's in the
next 2 to 3 decades.
More information
Read more about deep brain stimulation and other forms for
surgery in our free publications:
More forms of surgery for Parkinson's
Return to the surgical treatments of
Parkinson's main page
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