Parkinson's Disease

Deep Brain Stimulation (DBS) is a surgical therapy that is extremely effective for patients who suffer from movement disorders such as Parkinson’s disease (PD) and essential tremor.

The therapy consists of surgical implantation of one or two leads, with four electrical contacts into specific areas of the brain. The leads are attached by an extension wire to an implanted, battery-operated medical device called an impulse generator or neurostimulator. The DBS leads deliver electrical currents to the brain to modify abnormal nerve signals, lessening PD symptoms.

The symptoms that respond best to DBS are shaking (tremor), muscle stiffness (rigidity), slowed movement (bradykinesia) and dyskinesia (involuntary movements which is a side effect from medication). For some patients, it can improve walking.

The system can be turned on or off by the patient or by the clinician. The clinician can activate one or more of the four contacts on each brain lead to provide the stimulation and control, to some extent, a variety of electrical parameters or settings to control the amount of stimulation. These adjustments are often referred to as “programming” the DBS system. They allow the ability to maximize benefit and minimize side effects. Because DBS is entirely reversible and can be performed on both sides of the brain, the majority of patients choose DBS over the other surgical treatments.

There are two types of DBS systems: unilateral (placement only on one side of the brain) and bilateral (placement on both sides of the brain). Several pieces make up the DBS system, including:

• Lead—A metal wire that allows for transmission of electricity is surgically implanted into the brain. There are four different contacts at the end of the wire to allow for delivery of electrical impulses to the brain target site. The wire is just over a millimeter in diameter.
• Extension Wire—A wire runs from the brain electrode to the pulse generator.
• Implantable Pulse Generator (IPG), or Neurostimulator—A battery-powered device supplies electricity through the extension wire to the four contacts on the DBS lead.
• Programmer—A device that communicates with the IPG using radiowaves. This is used to set the electrical stimulation.
• Patient Controller—A remote control device allows the patient to turn on and off the IPG and to check the battery status.

The same team with you at the start also implants and programs your device. We know your symptoms and manage your medications, making the DBS programming process just an extension of your treatment.

Evaluation of PD, ET and dystonia begins with our movement disorders neurologist, Dr. Kelly Andrzewski or Dr. Daniel Sirica. If PD is suspected, a baseline unified Parkinson’s disease rating scale (UPDRS) should be performed. This scale helps the clinician evaluate the status of your PD. Preoperative tests may include MRI, x-ray, EKG, blood test and neuropsych evaluation.

DBS is a surgical therapy that is extremely effective for patients who suffer from movement disorders such as Parkinson’s disease (PD) and essential tremor. The Movement Disorders team has been successfully treating Parkinson’s disease, dystonias and essential tremor for more than 18 years. Our highly specialized movement disorders team is comprised of fellowship-trained physicians who serve those afflicted with PD as well as other movement disorders.

We participate in the most appropriate experimental protocols for the surgical and medical management of movement disorders. Surgical management consists of either DBS or an ablative procedure to treat PD, essential tremor and dystonia. Surgical procedures are performed by Dr. Robert Plunkett and Dr. Jonathan Riley, who specialize in stereotactic procedures.

Once the team has determined the patient is a candidate for DBS and the patient has decided to move forward with a surgical procedure, a choice is made as to whether the patient will receive Deep Brain Stimulation or an ablative procedure. If DBS is chosen, then an implantation site for the neurostimulator is also necessary.

Using the scans and tests mentioned, an internal map is drawn and is matched with external landmarks so surgeons can make an accurate incision using a local anesthetic. Surgery is performed by creating a burr hole in the skull about the size of a nickel. A microelectrode is then guided to the pre-selected target. This customized mapping process helps to fine-tune the exact location individually for each patient, to a desired accuracy of one millimeter or less.

A local anesthetic to numb the skin is administered when the surgeon makes the opening in the skull.

Once the patient has successfully recovered, the extension wire is placed. During this procedure the patient is placed under general anesthesia. The “pacemaker” is surgically implanted under the skin of the chest, just below the collarbone. The stimulator is turned on for the first time a few weeks post-operation. Programming does not require any further surgery.

As with any surgery, there are risks associated with deep brain stimulation therapy which are explained by your surgeon. The results can be dramatic and life-altering.

The hospital staff will provide you with discharge instructions for care of your incisions. Your DBS staff will provide you with information for follow up appointments for DBS programming and for dosing of your PD medications. This information will include phone numbers to call in case of emergency.

If you have additional questions about DBS and would like to speak to a nurse who specializes in caring for DBS patients, please call Pat Weigel at 716.218.1000 x6115.