DBS for Parkinson’s

Colin Halstead, OHSU patient, was able to return to his hobbies soon after he had DBS to treat Parkinson's disease.
Colin Halstead, OHSU patient, was able to return to his hobbies soon after he had DBS to treat Parkinson's disease.

DBS can be life-changing for some people with Parkinson's disease. It can reduce involuntary movements like tremors, relax rigid muscles, and improve slow movement (bradykinesia). DBS does not slow or cure Parkinson’s disease. But it can significantly improve your quality of life.

  • DBS can help if you have idiopathic Parkinson's and your symptoms improved with medication.
  • It involves two surgeries up to a week apart.
  • It works by regulating abnormal signals in the brain that cause movement symptoms.

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Am I a candidate for DBS?

DBS might be an option for you if medication no longer controls your movement symptoms well, or if it causes severe side effects.

You could be a good candidate for DBS if at least one of these situations applies to you:

  • You've been diagnosed with idiopathic, or classic, Parkinson's disease.
  • Your symptoms improved with medication like Sinemet (cardidopa-levodpoa).
  • Your medication no longer works as well as it once did.
  • Your medication causes troublesome side effects.
  • You need to take more types of medication, or more frequent or higher doses.

Who is not a good candidate for DBS?

You are not a good candidate for DBS if:

  • You do not have a clear diagnosis of Parkinson's disease.
  • You have “Parkinson’s plus” or an atypical form of the disease. “Parkinson’s plus” disorders include multiple system atrophy, progressive supranuclear palsy and vascular parkinsonism. DBS might make these disorders worse.
  • You have certain brain conditions, such as ischemic brain disease, demyelinating brain disease or brain tumors.
  • You are not healthy enough for surgery.

If you are evaluated for DBS and not a candidate, your OHSU movement disorders neurologist will recommend other options.

How DBS can help if you have Parkinson’s

DBS helps with the motor symptoms of Parkinson’s disease, such as:

  • Tremor that occurs at rest and that may be in one hand, foot or leg, or that affects both sides of the body.
  • Bradykinesia, or slow movement
  • Dyskinesia, or involuntary movement
  • Rigid muscles

Deep brain stimulation can also help with levodopa side effects, such as random, uncontrolled movements called dyskinesia.

Learn more about the benefits of DBS for patients with movement disorders.

DBS avoids the side effects that come with other Parkinson's disease treatments:

  • Medications for motor symptoms often become less effective over time. That means you may need more of the medication, with increasing side effects.
  • A type of surgery called a pallidotomy can help with Parkinson's motor symptoms. But it destroys part of your brain and can cause weakness, confusion, and problems seeing and talking.

DBS does not help with Parkinson's disease symptoms such as:

  • Constipation
  • Memory or thinking problems
  • Depression or anxiety
  • Swallowing problems
  • Balance problems

Preparing for DBS

Having a complete evaluation by movement disorder specialists is an important part of DBS for Parkinson’s. At OHSU, we bring a team of experts together to make sure you are a good candidate for DBS. Our team reviews your symptoms and medications, and talks with you about potential benefits and risks specific to your condition.

DBS appointments

Evaluation

You will meet with:

  • A neurologist who specializes in movement disorders
  • A neurosurgeon
  • A physical therapist who will evaluate your gait and balance over two days: first after you have not taken medication for 12 hours, then again after you resume
  • A speech therapist who will check how you speak and swallow
  • A neuropsychologist who will evaluate your memory and thinking
  • A social worker who talks about caregiving or other help you might need

Pre-surgery appointments

If you are a good candidate for DBS, you will have pre-surgery appointments with our team:

Internal medicine appointment: A provider in our Preoperative Medicine Clinic will make sure you are healthy enough for surgery and anesthesia.

MRI appointment: We will take a precise scan of your brain with a special MRI (magnetic resonance imaging) unit. The images will help your neurosurgeon plan where to place the electrodes during surgery.

If you live in the Portland area, your MRI appointment will be about two weeks before surgery. If you travel to OHSU from out of state, it will happen a few days before surgery.

Neurosurgery appointment: Your neurosurgeon will discuss the details of your surgery with you and answer your questions. We will also give you instructions for the day of surgery and care after surgery.

Surgery and beyond

DBS includes two surgeries and follow-up appointments. Learn more about DBS surgery and follow-up care.

First surgery: We place the DBS electrodes in your brain.

Second surgery: Up to a week after the first surgery, we place an implanted pulse generator (IPG) under your skin, just below your collarbone. We connect thin wires from the electrodes in your brain to the IPG.

After surgery: A month after the second surgery, we will adjust the DBS settings with a small device called a programmer. This can be done in our clinic or, in some cases, in your local neurologist's office. You will have monthly programming appointments for several months. After that, you will see your neurologist every six months for routine care and any needed adjustments.

DBS appointments for out-of-town patients

If you live outside the Portland area, we do everything we can to limit travel. We try to schedule appointments on the same day. In some cases, we offer appointments over a secure video connection from your local neurologist’s office. Your local neurologist can also help with some early and final appointments.

What to expect after DBS

The days and weeks after DBS surgery are different for everyone. But here are things to keep in mind:

  • When you return home, rest as much as possible. Slowly return to regular activities.
  • You have an especially high risk of falling in the weeks after DBS. Patients often feel overconfident after surgery. If you used a walker or cane before surgery, keep using it until you are stronger and steadier.
  • Your symptoms may improve temporarily after surgery. This is called the “microlesion” or “honeymoon” effect. It is normal for your symptoms to return to their pre-surgery level when the effect wears off. Your symptoms will then improve again as we program your DBS system.
  • It may take a few months of adjustments before your DBS system works as well as possible for you.

For patients

Call 503-494-4314 to:

  • Ask questions
  • Arrange a referral from your neurologist
  • Schedule follow-up appointments

Download our patient guides:

Location

Parking is free for patients and their visitors. 

Center for Health & Healing
Building 1, eighth floor
3303 S. Bond Ave. 
Portland, OR 97239 
Map and directions 

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