Deep Brain Stimulation Surgery is an exciting medical development which has helped thousands of people worldwide. This leading edge technology changes the way electrical signals flow through the brain. Changing these impulses improves some of the effects of Parkinson’s disease, essential tremor and dystonia among other conditions.
Some of our doctors are trained in the assessment and management of patients having deep brain stimulation surgery for Movement Disorders, making Neurology Network Melbourne one of the largest practices offering support and management for patients undergoing this procedure.
- A/Prof David Williams: he trained in London, and has been involved in over 200 cases in 15 years. He operates with A/Prof Andrew Danks at Jesse McPherson Private
- Dr Kelly Bertram: is an experienced programmer of DBS, managing patients with essential tremor, dystonia and Parkinson’s disease
- Dr Will Lee: is an experienced programmer of DBS and expertise in the management of patients with Parkinson’s disease, essential tremor and dystonia
- Nursing and Neuropsychology support is also an important aspect of this care
What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of disabling neurological symptoms. The debilitating symptoms of Parkinson’s disease such as tremor, rigidity, stiffness, slowed movement and walking problems, can improve with DBS. The procedure is also used to treat dystonia, essential tremor, orthostatic tremor and even depression. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications.
Deep Brain Stimulation is a well established procedure, with over 100,000 operations having been done world wide..
It is an option for patients in the middle stages of Parkinson’s disease, patients with disabling dystonia and patients with disabling essential tremor. We have also used this treatment for patients with neuroacanthocytosis and orthostatic tremor.
Deep Brain Stimulation uses a surgically implanted, battery-operated medical device called a neurostimulator. This is similar to a heart pacemaker and approximately the size of a small stopwatch. The device delivers electrical stimulation to areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms.
The surgical treatment of neurological disorders is not appropriate for everyone. All patients are carefully assessed for suitability and are seen by Dr Matthew Hughes, our neuropsychologist, for a thorough cognitive evaluation. A detailed psychiatric evaluation is also performed prior to the operation. After these assessments and review by the specialist Neurosurgeon that patients will be offered DBS by A/Prof Williams.
Before the procedure magnetic resonance imaging (MRI) and computed tomography (CT) scanning are used to identify and locate the exact target within the brain. It is at these points that electrical nerve signals generate the PD symptoms. Microelectrode recording (which involves a small wire that monitors the activity of nerve cells in the target area) is used to more specifically identify the precise brain target that will be stimulated. This target can be one of several parts of the brain circuits for movement, either the thalamus, subthalamic nucleus, and globus pallidus.
The DBS system consists of three components: the lead, the extension, and the neurostimulator. The lead is a thin, insulated wire that is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is positioned within the targeted brain area.
The extension is an insulated wire that is passed under the skin of the head, neck, and shoulder, connecting the lead to the neurostimulator. The neurostimulator (the “battery pack”) is the third component and is usually implanted under the skin near the collarbone. In some cases it may be implanted lower in the chest or under the skin over the abdomen.
Once the system is in place, electrical impulses are sent from the neurostimulator up along the extension wire and the lead and into the brain. These impulses interfere with and block the electrical signals that cause PD symptoms.
Click here to watch Channel 10 program covering DBS for Parkinson’s disease. 6.30 with George Negus, August 2011.
Is there any permanent nerve damage from treatment?
Unlike previous surgeries for PD, DBS does not damage healthy brain tissue by destroying nerve cells. Instead the procedure blocks electrical signals from targeted areas in the brain. Thus, if newer, more promising treatments develop in the future, the DBS procedure can be reversed. Also, stimulation from the neurostimulator is easily adjustable without further surgery, if the patients condition changes. Some people describe the stimulator adjustments as “programming.”
What is the prognosis?
Although most patients still need to take medication after undergoing DBS, many patients are able to substantially reduce their tablets. Few tablets uses translates into fewer side effects. This is important particularly for patients who experience duskiness (involuntary movements caused by long-term use of levodopa). In some cases, the stimulation itself can suppress dyskinesias without a reduction in medication.
Where can I find out more?
Many patients have questions regarding suitability for this type of procedure. Our Neurologists are able to discuss the role of DBS in patients referred by their GP or other specialists.