Deep brain stimulation, or DBS, is a type of surgery that can help people with movement disorders. A surgeon places tiny wires called electrodes in certain areas of the brain. The electrodes are connected to a small device that sends signals to the brain. When this happens, the electrodes correct faulty brain signals caused by Parkinson’s. This can help reduce certain Parkinson’s symptoms.
If you have Parkinson’s that is not well controlled with medication, or your medication causes severe side effects, deep brain stimulation might be an option. It does not cure Parkinson’s or slow its progress, but it does help many people with certain Parkinson’s symptoms. The information on this page can help you decide if you should consider deep brain stimulation surgery.
DBS could be for you if:
- Your Parkinson’s had gotten better with medication, especially levodopa.
- You find your medication no longer works as well as it once did.
- You now have severe side effects from your Parkinson’s medications.
- You need several medications to control your Parkinson’s symptoms.
- You need to take your medication more often, or you need higher doses.
You might think of deep brain stimulation as a last resort for people with long-term Parkinson’s. But even if you were just recently diagnosed, it’s not too early to consider how DBS might fit into your treatment plan, either now or in the future.
If you are interested in DBS, talk to your doctor about the information on this site. When you come to OHSU, you receive a complete multidisciplinary evaluation to learn if DBS is right for you. This includes appointments with a neurologist trained in movement disorders, a neurosurgeon, a physical therapist, a speech therapist and a neuropsychologist.
DBS helps with the motor symptoms of Parkinson’s that levodopa helps. These include:
- Tremor – Such as action tremors of the hands and wrists and head nodding (“yes-yes”) and head shaking (“no-no”) movements.
- Slow movement – Also called bradykinesia.
- Rigid muscles.
- Gait (walking) disturbance.
Deep brain stimulation can also help with levodopa side effects. Specifically, it helps with the changes in motor control that levodopa can cause, making you need to take it several times each day. It also helps with random, uncontrolled movements called “dyskinesias” that are a side effect of levodopa.
DBS does not help all Parkinson’s symptoms. For example, it does not help non-motor symptoms such as:
- Memory or thinking problems.
- Depression or anxiety.
- Swallowing problems.
- Balance problems.
Also, DBS does not help “Parkinson’s plus” symptoms. These include multiple system atrophy, progressive supranuclear palsy and vascular parkinsonism. In fact, DBS might make these symptoms worse.
DBS does not slow down the progress of Parkinson’s, and it is not a cure. But it can improve your quality of life.
- DBS can improve your quality of life by improving your motor function.
- DBS works 24 hours a day, so you depend less on medication to control your symptoms. But you can still take medication if it helps.
- DBS is reversible. Your DBS team can turn off the implanted pulse generator, also called the stimulator or IPG. This means you can try other treatments if they are available.
- DBS is adjustable. Your team can change the settings to make it more effective and reduce any side effects you have.
- DBS is renewable. The batteries last three to five years, and your DBS team can replace them.
Medications can help with motor symptoms of Parkinson’s. But they often become less effective with time. Medications can also cause side effects. If you need more and more medication, the side effects can also increase. This can make it hard to take enough medication to control your symptoms.
A type of surgery called a pallidotomy destroys part of the brain that controls movement. This can stop some of the motor symptoms of Parkinson’s. However, it can also cause side effects, including bleeding, weakness, confusion and problems seeing and talking.
In "asleep" DBS, developed by OHSU's Dr. Kim Burchiel, the patient is placed under general anesthesia. The patient is not aware of any part of the procedure. The neurosurgeon uses high-resolution scans taken before and during surgery to precisely place the tiny electrodes in the brain. "Asleep" DBS is faster and safer. Patients can also take their medication on the day of surgery.
In "awake" DBS, the patient must remain awake during surgery. This is because the patient needs to respond or perform tasks to help the neurosurgeon correctly place the DBS electrodes in the brain. Many patients are anxious about being awake during brain surgery. They also must refrain from taking their medication on the day of surgery. OHSU no longer performs awake DBS.
How does my neurosurgeon test the electrodes if I am asleep?
Your neurosurgeon does CT scans, sometimes called CAT scans, during surgery. Your neurosurgeon compares these with the high-resolution MRI you had before surgery. By comparing these precise scans, your neurosurgeon knows when the electrodes are in the right place. He or she can find the best location without having to move the electrodes around, as in awake DBS.
The cost of deep brain stimulation is different from person to person, depending on insurance and other factors. The OHSU Parkinson's Disease and Movement Disorders team will work with you to help you learn about insurance coverage and costs.
Does Medicare cover DBS?
Yes, if you qualify. Read the Medicare standards for DBS or consult with them for more information. If you meet the Medicare standards for DBS, you do not need Medicare approval before surgery. You must still pay deductibles, coinsurance, and copayments.
What about other health insurance?
Non-Medicare health insurance often covers DBS if you get approval before surgery. Your doctor’s office usually has to work with the company to get approval, called “authorization.” Your doctor often writes the insurance company a letter saying why DBS is appropriate for you. It also describes other treatments you have tried that do not work well.