What to know about deep brain stimulation (DBS) and Parkinson's disease

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During a DBS procedure, a surgeon inserts thin metal wires, or electrodes, into the brain. They also place an impulse generator (IPG), or neurostimulator — which is like a pacemaker — under the skin of the collarbone, chest, or abdomen.

The person can use a controller to turn the IPG on and off. When it is on, the IPG communicates with the electrodes. It tells them to generate an electrical current that stimulates the production of certain chemicals in the brain.

According to the American Association of Neurological Surgeons (AANS), healthcare professionals can use DBS to treat:

• Parkinson’s disease
• dystonia, or involuntary muscle contractions
• tremor
• epilepsy
• obsessive-compulsive disorder

According to the National Institute of Neurological Disorders and Stroke (NINDS), Parkinson’s disease is a progressive condition. It affects the neurons, or brain cells, that make dopamine.

Dopamine is a neurotransmitter, or chemical, that the body makes to send messages between certain nerve cells that control movement. Without dopamine, these nerve cells cannot talk to each other.

These neurons are usually located in the substantia nigra pars compacta. This is a structure in the brain that people refer to as the basal ganglia.

A lack of dopamine causes many of the motor symptoms of Parkinson’s disease, including:

• tremor
• bradykinesia, or slow movement
• rigid limbs
• balance problems
• gait problems

At the beginning of the condition, a person can take a medication called levodopa to treat Parkinson’s disease. However, during the later stages, this medication may not work as well. It can also cause uncontrolled involuntary movements called dyskinesia.

DBS can treat the motor symptoms of Parkinson’s disease, and it can also reduce the need to take levodopa.

A small 2019 study states that in some people, DBS raises the dopamine levels in the brain, which can treat the motor symptoms of Parkinson’s disease.

Exactly how it does this is not completely understood. However, the researchers suggest that the electrical impulses affect the nerve cells that produce dopamine.

DBS does not cure or slow the progression of Parkinson’s disease. However, many people report that it helps them control the motor symptoms of the condition.

The Parkinson’s Foundation says that DBS improves symptoms in many people. However, it is different for everyone.

Some people experience a mild improvement, while others experience a significant improvement. Some people may be able to stop taking their Parkinson’s disease medication, while others will not.

DBS is not the right treatment choice for everyone. Doctors tend to only recommend it in advanced Parkinson’s disease and when more standard medications are not working as well as they should.

According to the Parkinson’s Foundation, people who are best suited to DBS:

• have had Parkinson’s disease symptoms for at least 5 years
• experience “on/off” fluctuations in symptoms, even though they are taking medications
• have dyskinesia
• cannot take anti-Parkinson’s disease medications because of the side effects
• have a tremor that medications cannot control
• have Parkinson’s disease symptoms that interfere with their everyday life
• have Parkinson’s disease symptoms that interfere with their quality of life

Before the operation, a person will need to undergo a series of tests. These include:

• blood tests
• urine tests
• MRI or CT scans

There are three components of the DBS system:

• The lead: This is also called an electrode. It is a thin, insulated wire.
• The extension: This is another insulated wire that connects the lead to the neurostimulator.
• The neurostimulator, or IPG: This is essentially the battery pack.

According to Johns Hopkins, during the procedure, a surgeon will implant the three pieces of the DBS system into the person’s body.

Lead implantation

To implant the lead, a surgeon will perform the following steps:

1. The surgeon will shave the person’s hair located behind the hairline.
2. After injecting a local anesthetic, they will place a head frame using screws. This helps keep the head in place.
3. Using a CT or MRI scan, the surgeon will pinpoint where the lead will go. The NINDS notes that to treat the motor symptoms of Parkinson’s disease, a surgeon will place the leads in the subthalamic nucleus or the globus pallidus interna. These are the internal sections of a part of the brain called the globus pallidus.
4. The surgeon will then drill a small hole into the skull to insert the lead. At this point, they may ask the person to answer questions or perform certain tasks, such as moving the arm or leg.
5. Once they have placed the lead into position, they will attach the external neurostimulator. This helps the surgeon see if the symptoms improve or if side effects appear.
6. They will then connect the extension wire under the scalp to connect the lead to the neurostimulator.

Placing the neurostimulator and extension wire

At this point, a person will be under general anesthesia. The surgeon will typically place the neurostimulator under the skin, just underneath the collarbone. Alternatively, they may place it in the chest or abdomen.

They will then attach the extension wire from the lead to the neurostimulator.

Afterward

The person may need to stay in the hospital for 24 hours.

After returning home, they need to ensure that they keep the incisions clean and dry.

A few weeks after the procedure, a Parkinson’s disease specialist will program the device to treat the person’s symptoms. Finding the right settings can take time, sometimes several months to a year.

People can turn the electrodes on and off using a hand-held controller.

The AANS notes that DBS is safe and effective in those who are good candidates for the procedure. Risks and potential side effects tend to be mild and reversible.

Some risks of DBS may include:

• a 1% chance of a brain hemorrhage
• infections
• a device malfunction
• headaches
• a worsening of mental or emotional symptoms

The AANS also says that the procedure may not work for some symptoms.

Some potential side effects when using the device include:

• tingling in the face, arms, or legs
• a pulling feeling in the muscles
• speech problems
• vision problems
• balance problems

Johns Hopkins notes that people may wish to do the following after surgery:

• Carry an ID card or wear a medical information bracelet that states that they have a DBS neurostimulator.
• Check with a doctor before undergoing any type of MRI procedure.
• Avoid using heat if they undergo physical therapy.
• Protect the neurostimulator area from trauma if they take part in sporting activities.
• Always inform a doctor that they have a neurostimulator before undergoing any surgical procedure.
• Avoid high voltage or radar machinery.

A 2016 cost analysis found that the average cost of DBS was approximately $39,000.

Medicare may cover the cost of the procedure.

DBS is a surgical intervention for people with Parkinson’s disease. It involves a surgeon inserting electrodes into the brain to stimulate the production of dopamine.

It is not a cure for Parkinson’s disease, and it does not slow the progression of the condition. However, many people say that it helps them control their motor symptoms. These include tremor, bradykinesia, and balance and gait problems.

Healthcare professionals tend to only recommend the procedure when other interventions, such as medications, have not worked.

There are a few possible side effects, but the procedure is generally safe.

Health insurance policies usually cover DBS.