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Deep brain stimulation

Although the main treatment for Parkinson's is medication, there are some types of surgery available to treat the symptoms of the condition. Deep brain stimulation (or DBS) is the main type of surgery used.

Everyone with Parkinson's is different. Although deep brain stimulation has improved my life, it may not be right for someone else.

It's not a cure, but it can give some people better control of their symptoms.

It may help to reduce some movement symptoms of Parkinson's, such as slowness of movement, stiffness and tremor.

It may also mean that someone has to take less medication, which can reduce the risk of medication side effects, such as involuntary movements (dyskinesia).

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.

For more about deep brain stimulation and other forms for surgery, take a look at our free Surgery for Parkinson's booklet.

Who is suitable for deep brain stimulation?

Not everyone will be suitable for deep brain stimulation and it won't work for everyone who has the operation.

But you can discuss the option with your specialist or Parkinson's nurse.

Where is deep brain stimulation carried out?

This type of surgery is carried out at certain centres in the UK.

Someone considering deep brain stimulation may choose which centre they are referred to, even if a centre is not near their home.

How is the operation paid for?

Deep brain stimulation is an expensive procedure and the surgical centre will generally apply for funding from the body that funds healthcare in the relevant area.

There will be different funding agreements available in different areas.

What does deep brain stimulation involve?

Deep brain stimulation involves implanting leads, which have electrodes at the end, 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)

As a family we've always believed a risk is worth taking. The results have made everything worthwhile.

The leads are usually implanted under local anaesthetic, so the person will be awake. Alternatively, they may be woken up part-way through the operation.

A small electric current will be sent through the leads to test how the person's symptoms respond to medication, to make sure they have been put in the right place.

The leads are connected to extensions that are tunnelled under the skin behind the ear and down the neck. They are then connected to a neurostimulator (a device like a pacemaker), which is placed under the skin around the chest or stomach area.

During this part of the procedure, which will either be part of the first operation or separate, the person will be put under general anaesthetic (so they are asleep).

Neurostimulator devices

There are 2 types of neurostimulator: a non-rechargeable and a rechargeable device.

The majority of people with Parkinson's who have had deep brain stimulation are fitted with a device that contains a non-rechargeable battery.

On average, the battery lasts between 3 and 5 years depending on the stimulator settings, but some may last longer before a replacement is needed.

Some people may have a device that contains a rechargeable battery. Someone with a rechargeable stimulator will be given and taught how to use a recharging unit.

Once the wounds from surgery have healed, the device will be switched on and the electrodes will deliver high-frequency stimulation to the area of the brain that is targeted. This stimulation will change some of the electrical signals in the brain that cause the symptoms of Parkinson's.

A specialist or Parkinson's nurse will programme the stimulator using a small computer.

Adjusting the device

Someone with a device fitted will be given instructions on how to use their own programmer. This will allow them to adjust the stimulation and check the battery life.

The stimulator may continue to be adjusted over a period of time.

It may take several months to fully programme the stimulator and adjust Parkinson's medication to get the most benefit from this treatment.

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.

People who were in paid employment before their operation are usually able to return to work after full recovery from surgery.

Everyday activities and travel

If you have deep brain stimulation, you may not be able to drive for 6 months after your operation.

After my husband had the surgery his tremor became worse and he was exhausted after 2 operations. I was worried it hadn't worked, but after 4 months we started to see a real improvement.

Most everyday activities are safe, but welding is not. And there are some sports that could damage the system.

If you've had deep brain stimulation you can travel by plane, but you should inform airport security and carry a card that explains that you have had this type of surgery.

You should also carry the hand-held programmer when travelling. This is in case the stimulator is accidentally switched off.

Other things to bear in mind

Make sure you make hospital staff and other healthcare professionals, including dentists and physiotherapists, aware if a neurostimulator has been implanted.

MRI scans, a type of brain scan, can only be used under very strict conditions. Antibiotics have to be prescribed when there is a risk of germs getting into the blood stream, for example during dental procedures or surgery.

Diathermy is the use of a high frequency electronic current to produce heat and is often used to relax muscles. It should not be used on someone who has had deep brain stimulation.

People's experiences of deep brain stimulation

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