Deep Brain Stimulation: Pros and Cons

DBS, also known as deep brain stimulation, has replaced other hallmark procedures when it comes to treating PD symptoms. Although not a cure for PD, nor a procedure that can change the underlying progression of the condition, it is utilized as a means to reduce or eliminate some PD symptoms.

How does it work?

Essentially, electrodes are placed deep into the brain and deliver electrical impulses and signals to specific brain cells. The exact mechanism by which DBS works is not completely known.

However, it is theorized that the electrical impulses delivered by the electrodes work to regulate and reset faulty electrical communication between brain cells that leads to PD symptoms such as tremor and dyskinesia.

A team of healthcare providers will determine if DBS is right for your specific situation. In most cases, it becomes an option for those who have had PD for at least 4 years, and who have breakthrough symptoms while on levodopa, leading to significant 'off" time.

As with any procedure, there are risks and benefits to DBS. Check out the lists below for some of these pros and cons!

What are the benefits?

• Symptom reduction: DBS often reduces symptoms significantly. These include motor symptoms like stiffness, tremor, slowness and dyskinesia. DBS has also been shown to aid in on/off fluctuations, improve mood and quality of life, and increase overall energy level.
• Little to no damage: In contrast to previous methods, DBS does not damage portions of the brain, nor remove nerve cells.
• Decreased medication needs: Utilizing DBS in addition to levodopa could decrease a person’s need for medication, thus, decreasing medication access and cost issues, as well as levodopa side effects.
• Individualized treatment: Electrodes and stimulation frequency and intensity can be controlled by physicians and the individual with DBS, and can be subjectively altered when needed.

What are the risks?

• Invasive and awake during procedure: The procedure does involve an incision to the scalp, and access to deep parts of the brain. Additionally, most individuals are awake during the procedure, which could be a scary situation for some.
• Not all symptoms addressed: Typically, symptoms that would respond to levodopa respond the best to DBS. Other symptoms that aren’t managed by levodopa are generally unaffected.
• Surgical side effects: As with most surgical procedures, there are risks associated with surgery itself. These include the risk of bleeding, stroke, infection, and accumulating fluid in the brain. Also, since the brain is a complex and sensitive organ, it is possible for essential areas of the brain to get hurt during the procedure and cause additional symptoms unrelated to PD.
• Future danger around certain electronics: Basic electronics are usually fine for those with DBS to be around, however, larger, more powerful machines, like total body coil MRI, may be off-limits post-procedure.
• Malfunction and battery replacement: It is possible for the hardware to malfunction, wires to disconnect, and the electrodes to shift. Additionally, the battery life of the devices and controllers need to be monitored relatively frequently.
• Expensive: Although many insurance companies may cover part or all of DBS, the procedure can run anywhere from $30,000-$100,000.
• Results aren’t immediate: It can take months to determine the exact balance of DBS stimulation and medications to optimally control symptoms. While certain symptoms may subside almost immediately, it may take a long amount of time to find the right combination for long-term effects.

Let us know if you’ve had DBS and how it has impacted you, or if you’re considering DBS in the future!