Deep Brain Stimulation for Parkinson's Disease

The DBS system is usually implanted in two stages. In the first stage, the electrode is guided through the small hole in the skull to the target location in the brain, which has been pre-selected by MRI. This process is done in part while the patient is awake for test stimulation of the electrode, to confirm proper placement during the surgery.

After this electrode placement, patients stay in the hospital for observation, typically for one night. About 2 weeks later, patients return for placement of the battery-operated pulse generator in the chest area. During this 2nd procedure, the wire from the electrode and the wire from the pulse generator are connected with each other. This procedure is typically a one-day stay, similar to the placement of a cardiac pacemaker.

Several effective medications are available for Parkinson's disease, including carbidopa/levodopa, dopamine agonists, and others. As the disease progresses, these medications often don't provide uninterrupted benefit any longer; rather, patients typically experience wearing off, on- and off-periods, and fidgety-like involuntary movements called dyskinesias.

DBS provides good benefit for certain symptoms (including slowness, stiffness, and tremor). Importantly, fluctuations (like wearing off and on-off-phenomena) usually improve a lot in response to DBS, since the stimulation goes on in an uninterrupted fashion. Although patients typically still need to take medication after undergoing DBS, they can often reduce their dosages so much that side effects (such as dyskinesias) improve substantially. Other symptoms, including balance problems, falls, and often speech impairment, may not respond favorably to DBS surgery.

Unlike older types of surgery for Parkinson's disease, DBS does not involve intentional destruction of brain tissue. The jamming signal from DBS is adjusted as an outpatient to provide the patients with the optimal symptom relief. Also, as the patient's condition changes, the pulse generator device can easily be re-programmed. Further surgery is not needed until the battery in the chest is replaced, typically three to five years later.

DBS, like all forms of brain surgery, has a small risk of infection or bleeding. Computer-guided brain imaging is used to reduce the risk of bleeding when the electrode is inserted into the brain. Rarely, significant bleeding into the brain can occur with stroke-like signs such a weakness on one side of the body. Some patients also experience short-term confusion.

DBS is used only for patients with at least moderately severe Parkinson's, who aren't getting adequate control of their symptoms with medications. The ideal candidate will have motor fluctuations, gait impairment without frequent falls, and minimal or no cognitive impairment, among other criteria and considerations.

The University of Maryland Parkinson's Disease and Movement Disorders Center offers a comprehensive management and treatment approach for patients and their families found at only a handful of Centers across the country.

Our dedicated DBS team consists of highly experienced experts from our Departments of Neurology and Neurosurgery. Every candidate for surgical intervention is examined very carefully, including comprehensive psychiatric and neuropsychological evaluations. The team also guides and follows each patient through the 2 hospitalizations and provides frequent and detailed follow-up care in the weeks, months and years after the surgery. We have many years of experience, and excellent results in DBS treatment for Parkinson's disease, Essential tremor, and dystonia.