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Deep Brain Stimulation: A Neurological Perspective
Bradley C. Hiner, MDMedical College of Wisconsin Movement Disorders Neurologist
Deep brain stimulation is a surgical procedure introduced in the 1990s to treat movement disorders. The procedure can dramatically improve symptoms and allow patients to resume normal activities, but it is not commonly available since it requires specialized equipment and a highly trained staff. Movement disorders specialist, Bradley Hiner, MD, describes this safe and effective treatment option now available at Froedtert & Medical College of Wisconsin.
Q. What is deep brain stimulation and what type of conditions does it help?Deep brain stimulation (DBS) is an exciting new surgical option in our arsenal of treatments for movement disorders. Any patient with a movement disorder who is not responding adequately to medications may be considered. It is an especially effective option for patients with moderate severity Parkinson's disease who are becoming less and less responsive to medication, and for patients with essential tremor. It can also help individuals with certain types of dystonia and tremor due to multiple sclerosis.
During DBS surgery, an electrode about the thickness of a strand of spaghetti is implanted into the area of the brain causing symptoms. It is then connected to a battery placed underneath the skin of the collarbone, much like a heart pacemaker. When activated, these electrical impulses suppress abnormal movements resulting in improvement in the target symptoms of tremor, rigidity, slowness of movement and stiffness.
Q. What type of follow-up care does the patient require?After recovery, the patient will have the implant adjusted for maximum reduction of side effects and optimal control of symptoms. In most cases, patients still require some medication, but usually in lesser amounts. We work with patients to find a good balance between electricity and chemistry. In some instances, a patient may go through physical, occupational and speech therapy to further improve function. A movement disorder specialist can program and "fine tune" the DBS in an outpatient setting to provide the best combination of treatments to meet an individual patient's needs.
Q. How successful is DBS in treating symptoms?While DBS is not a cure, significant improvement is seen in most cases with low risk to the patient. For example, we can expect DBS to improve symptoms of tremor by 80 to 90 percent in patients with Parkinson's disease and essential tremor. MS patients see a lesser but still significant improvement. Patients who had previously found it difficult to do even simple activities, such as eating and drinking, obtain marked improvement in activities of daily living.
In individuals with Parkinson's disease, we can improve certain symptoms better than others and we can rank the order of symptoms we expect to improve. The number one symptom that is improved is tremor, followed by muscle rigidity or stiffness. In the operating room, we see tremor improve within a matter of seconds and muscular rigidity in a couple of minutes. But the third symptom on our list — bradykinesia or slowness of movement – may not improve as rapidly. It could take days or weeks. And the fourth symptom — trouble with balance and walking — may or may not improve over time. But DBS does allow most patients to experience an increase in good quality "on" time with less tremor, stiffness and slowness of movement. And it almost always allows patients to get by on less medication and thus have fewer side effects.
Author: Bradley C. Hiner, MD Source: Every Day Date: May - August 2005 |