Evaluating Parkinson's patients for DBS
Deep brain stimulation, or DBS, should be considered for patients whose motor symptoms are no longer effectively treated with medication. These patients may have "on" times, with disabling involuntary movements or non-motor side effects, and "off" times of disabling tremor, rigidity and difficulty moving or slow movements despite optimized medication management. Motor abilities may fluctuate unpredictably and medications may no longer control tremor. These symptoms mark the start of the time when DBS is typically most effective.
Some patients with Parkinson’s are not candidates for DBS. Those with “Parkinson’s plus” conditions will not benefit from DBS, and symptoms will likely worsen. Parkinson’s plus conditions include multiple system atrophy, progressive supranuclear palsy and vascular parkinsonism.
Patient selection criteria
The chance of successful treatment is the most important factor in selecting patients who benefit from DBS for Parkinson’s. Patients who are marginal candidates, or whose multidisciplinary evaluation raises questions about risks versus benefits, will be informed, and our DBS team will discuss the issues with you. Contraindications to deep brain stimulation for Parkinson’s include:
- End-stage PD – Patients who are severely disabled despite medication will not benefit appreciably from DBS.
- Lack of definitive PD diagnosis – DBS is contraindicated for atypical parkinsonism and patients without a clear diagnosis of idiopathic Parkinson’s disease.
- Disease has not responded to levodopa or carbidopa-levodopa (Sinemet)
- Poor motor function even when taking medication – For example, unable to walk without significant assistance. DBS typically raises patient function to the level of the optimal “on medication” state.
- Poor cognitive abilities – DBS is also contraindicated for patients with dementia and moderate to severe depression.
- Co-morbidities – Any serious coexisting chronic illness, including other neurological diseases, serious cardiac disease, or uncontrolled hypertension. DBS is contraindicated in patients with coagulopathies.
- Age under 18
We can provide extensive workups for all patients with movement disorders. This includes appointments with a movement-disorders trained neurologist, neurosurgeon, physical therapist, speech therapist and neuropsychologist.
This information helps us advise you and your patient on deep brain stimulation, analyze personal risks and benefits, and determine which target in the brain is appropriate to improve symptoms.