Understanding Deep Brain Stimulation (DBS) for Parkinson’s

Deep Brain Stimulation (DBS) for Parkinson’s: What Is It?

Deep Brain Stimulation (DBS) is an advanced treatment option for Parkinson’s. In addition to movement disorders, DBS can also help manage severe cases of obsessive-compulsive disorder (OCD) and certain types of epilepsy.

This article explores DBS as a treatment for managing Parkinson’s. Read on and learn how DBS works, the Parkinson’s symptoms it addresses, who it’s for, and the long-term outcomes of treating Parkinson's with DBS.

What Is DBS and How Does It Work?

DBS is a type of invasive surgery used to treat Parkinson’s. Surgeons insert one or two thin wires, called leads, inside the patient’s brain and a pulse generator around the chest or abdomen areas. Each lead splits into multiple electrodes (fine metal contacts) that deliver precise electrical pulses to specific areas of the brain.

The leads run to the pulse generator which is a battery-powered neurotransmitter similar to a heart pacemaker. It sends high-frequency electrical signals up the leads to the electrodes in the brain.

After surgery, the pulse generator is turned on and programmed to match the patient’s symptoms. This initial programming sets the DBS’s pulse timing, frequency, intensity, and duty cycle. Clinicians then try different setting combinations to program the ideal configuration that manages symptoms with minimal side effects.

The first few months after the initial programming, the patient may have to check in a couple of times with their neurologist to fine-tune the device. During follow-up programming sessions, the neurologist adjusts the pulses based on the patient’s response to previous settings. This continues until the therapy stabilises and becomes predictable.

DBS is an ongoing treatment. As the Parkinson’s progresses, the device must be continuously programmed to match the advancing symptoms.

How DBS Improves Parkinson’s Symptoms

Deep brain stimulation generally manages movement-related symptoms, such as tremors, stiffness, and slowed movement.

Parkinson’s is characterised by a reduction of dopamine levels in the brain. The drop in dopamine disrupts neuron activity in an area of the brain called the basal ganglia, which is responsible for motor control. This is the root of most motor symptoms of Parkinson's.  The basal ganglia both initiate and amplifies while also regulate and inhibits motion. When dopamine stops stimulating these neuronal circuits, the inhibition function takes over. It behaves then alike a car with an unresponsive throttle and its breaks pressed on, which makes for a slow and bumpy ride.

Electrical pulses from DBS treatment suppress the neuronal firing patterns engaging the inhibitive function of the basal ganglia. It is like pulling the breakup. Likewise, this pulse can also suppress tremorous firing transiting as well through these deep brain networks. In a nutshell, that’s how the treatment helps relieve movement dysfunction in people with Parkinson's.

While DBS also lessens the frequency and intensity of dyskinesia, it’s not really a symptom of Parkinson's. Dyskinesia affects over 90% of individuals who’ve had Parkinson’s for 10 years or longer, largely as a side effect of dopaminergic therapies. DBS helps with dyskinesia either directly or by reducing levodopa dosage and thereby warding off its side effects.

Scientific studies and clinical evidence suggest that DBS improves non-motor Parkinson's symptoms too. Researchers have linked DBS to improved bladder control, sleep, pain management, anxiety, gastrointestinal symptoms, and impulse control.

However, certain symptoms or traits, such as speech, gait, postural stability, and cognition, may worsen after DBS surgery.

Who can access DBS Treatment

As much as DBS is an effective treatment for Parkinson’s, not every person with Parkinson’s meets the eligibility criteria for the treatment. In fact, very few get DBS treatment. A 2023 survey found that only 14% of people with Parkinson’s had undergone DBS surgery, most of whom have been living with Parkinson’s for over seven years.

Anyone considering DBS must undergo a series of tests and assessments to determine their suitability for surgery. Generally, in the UK, the assessments and checks include:

• Having Parkinson’s for over five years

• A significantly impaired quality of life due to movement disorders

• Good response to dopaminergic therapies with clearly defined ON and OFF states

• Severe motor fluctuations that cannot be controlled by adjusting medication

• Significant dyskinesia

• Relatively stable mental health—no dementia or significant memory and cognition problems

• Medically fit for surgery

• Below the age of 70, as surgery risks increasing with age.

DBS is often the last resort when it comes to Parkinson’s treatment. In most cases, doctors recommend the surgery in the late stages when motor symptoms become increasingly overwhelming and barely manageable with medication.

Clinical experts continue to investigate the efficacy of DBS in early and mild Parkinson's cases. In one study, researchers found that access to early DBS surgery reduces the need for and complexity of Parkinson’s medications while providing long-term motor benefits.

Long-Term Outcomes of DBS Treatment

DBS does not stop or slow down Parkinson's progression. Instead, it provides durable symptomatic relief medication becomes ineffective. That said, people with DBS implants continue taking medication (often at lower doses) to complement the stimulation and address non-motor symptoms.

Patient satisfaction with DBS ranks quite high. For example, in the 2023 survey cited earlier, 75% of those implanted with a DBS were happy with the treatment, and 85% said they would recommend DBS to others. Studies show that DBS significantly improves the quality of life for people living with movement-debilitating Parkinson's. In addition, the treatment is associated with a 10-year survival rate of 51%.

Conclusion

DBS presents the opportunity to support numerous people with Parkinson’s manage motor symptoms, reduce levodopa dosage, and improve their quality of life. It’s also an evolving medical technology, with companies like SERG Technologies pioneering the next generation of DBS programming. DBS could quickly become the more advanced, accessible, and effective Parkinson’s treatment.