Deep brain stimulation uses electrical impulses to stimulate a
target area in the brain. The stimulation affects movement by altering the
activity in that area of the brain. The procedure does not destroy any brain
tissue. And stimulation can be stopped at any time by turning off the device
that supplies the electrical impulses.
Surgery is required to implant the equipment that produces the
electrical stimulation. You are awake during the procedure (your scalp is
numbed and you won't feel any pain), because you must work with the surgeon in
placing the electrodes where they will have the most benefit. A small hole is
drilled in your skull, and tiny wire electrodes are placed in your brain. A
small battery-powered device (generator) similar to a pacemaker is implanted in
your chest and connected to the electrodes in your brain by a wire. The
procedure usually takes 3 to 4 hours, although it may take as long as 8 hours.
When the device is turned on, it sends 100 to 180 electrical pulses
per minute to stimulate the specific area of the brain. You can turn the device
on and off by holding a magnet against the skin over the device. Newer models
can be turned on and off with a small remote control unit. The device can be
programmed so that it delivers the correct level of stimulation to provide the
greatest relief of symptoms.
You will remain in the hospital for several days after the
procedure while your doctor checks the effect of deep brain stimulation.
Deep brain stimulation may be used to relieve symptoms of
Parkinson's disease, especially tremor, when they
cannot be controlled with medicine. It is considered the surgical treatment of
choice for Parkinson's disease, because it is more effective, safer, and less
destructive to brain tissue than other surgical methods.
Deep brain stimulation of the thalamus is done to treat both disabling
tremor caused by Parkinson's disease and essential tremor.
Procedures that stimulate the subthalamic nucleus and the globus
pallidus are done to help control a wider range of symptoms (in addition to
tremor) and are used more often than stimulation of the thalamus.
Deep brain stimulation may also be used to treat severe tremor related to multiple sclerosis (MS). Deep brain stimulation usually
is a last resort after all other options have been tried without success to
treat MS tremor. Only people with severe tremor are candidates.
Deep brain stimulation of the thalamus is effective in reducing
tremor. It does not affect slow movement (bradykinesia), stiffness (rigidity),
or other symptoms.1
Deep brain stimulation of the subthalamic nucleus:2
There is not enough evidence to say how well deep brain stimulation of the thalamus or globus pallidus works to control motor complications or improve motor symptoms in Parkinson's disease.3
Risks of deep brain stimulation include:
A neurologist with special training in Parkinson's disease is most
often the best kind of doctor to make a decision about deep brain stimulation.
If you might benefit from the operation, your neurologist can refer you to a
brain surgeon with experience doing the surgery.
Deep brain stimulation may be considered as an addition to levodopa
therapy, not a replacement for it. It does not cure Parkinson's disease and
does not eliminate the need for medicine. The surgery can help maintain and
extend the benefits of levodopa therapy. But it should not be considered for
people with Parkinson's disease who also respond poorly to levodopa
One of the possible advantages of deep brain stimulation over
"lesional" surgery for Parkinson's disease (such as pallidotomy) is that it can
be reversed. Although the effects of lesional surgery, which involves creating
a lesion or intentionally destroying a small portion of the brain, are
permanent, the electrodes used in deep brain stimulation can be turned off or
removed if they cause problems.
Deep brain stimulation for tremor caused by multiple sclerosis (MS) is still experimental, expensive, and not widely available.
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CitationsSamii A, et al. (2004). Parkinson's disease.
Lancet, 363(9423): 1783–1793.Deep brain stimulation for Parkinson's disease (2009). Medical Letter on Drugs and Therapeutics, 51(1309): 26–27.Pahwa R, et al. (2006). Practice parameter: Treatment
of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based
review). Report of the Quality Standards Subcommittee of the American Academy
of Neurology. Neurology, 66(7): 983–985. Also available online: http://www.neurology.org/content/66/7/983.full.
February 15, 2012
Adam Husney, MD - Family Medicine & Anne C. Poinier, MD - Internal Medicine & Barrie J. Hurwitz, MD - Neurology
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