Deep brain stimulation has been used for years in the treatment of advanced Parkinson's disease. It helps to significantly improve the patient's quality of life - he can walk independently and the tremors disappear. What is electrode treatment for Parkinson's disease? Which patients qualify for deep brain stimulation? What are the side effects of this method?
Deep brain stimulation(deep brain stimulation -DBS ) is usedto treatadvanced brain stimulation charactersParkinson's disease . Parkinson's disease is incurable, but deep brain stimulation improves the patient's quality of life.
Initially, oral medications (mainly levodopa and dopamine agonists) are used to treat Parkinson's disease. However, the constant progression of the disease causes their effectiveness to gradually decrease.
When medications are given at increasing doses multiple times a day, and yet symptoms cannot be relieved, one of three treatments for advanced Parkinson's disease should be started.
The first is electrode treatment, i.e. deep brain stimulation, the second is a subcutaneous pump using apomorphine, and the third is a pump that pumps levodopa (the most effective drug in Parkinson's disease) directly into the duodenum.
Only deep brain stimulation is reimbursed in Poland.
Deep brain stimulation - indications
Eligibility rules for deep brain stimulation in Parkinson's disease:
- diagnosis of Parkinson's disease based on the United Kingdom Parkinson's Disease Brain Bank criteria
- at least 5 years of illness (this is the period necessary to confirm that the patient is suffering from this condition)
- patient's age - less than 70 years (the use of DBS in older patients each time requires careful consideration of potential benefits and side effects)
- exhaustion of the possibilities of optimal pharmacological therapy conducted with oral medications (≥ 4 hours a day of the total time of states off and / or ≥ 4 hours a day of the total time of on states with troublesome dyskinesias; documented by entries in the Hauser diary)
- levodopa response saved
- no dementia
- no depression and mood disorders other than off-related
- no significant psychotic symptoms
- no significant atrophic or hyperintensive changes in the brain's MRI (magnetic resonance imaging) image
- no contraindications to pacemaker implantation due to comorbidities
Depression, mild dementia, and a history of stroke are some of the contraindications for brain pacemaker implantation.
Deep brain stimulation - what is it?
Deep brain stimulation involves placing electrodes in the appropriate structure of the brain (the low-thalamic nucleus or the inner part of the pale globe), which are connected by a wire with a stimulator placed under the skin on the chest.
The patient undergoes magnetic resonance imaging the day before the operation. The next day, the surgical procedure begins with putting a special, metolic stereotaxic frame on the patient's head and performing computed tomography. Test results are entered into a computer that processes images of the brain. Thanks to this, it is possible to precisely determine the point to which the doctor is to insert the electrode.
During the first part of the operation, the patient is conscious. Only local anesthesia and sedatives are given. The physician must contact the patient to check that the stimulation is not causing any adverse effects. Near the stimulated part of the brain there are structures responsible, for example, for movement or speech.
The doctor drills a small hole in the skull through which he introduces an electrode into the brain and stimulates it. If the patient and the neurological tests performed during the operation confirm that the electrode is not causing any adverse effects, it stays in place and a special plug is inserted into the previously drilled hole. The patient is then given a general anesthetic to implant a pacemaker in the clavicle area. It is connected to an electrode in the brain with a cable.
Deep brain stimulation in the treatment of Parkinson's disease is fully reimbursed by the NHF.
ImportantDeep brain stimulation reduces and sometimes even discontinues medication in Parkinson's disease.
The effectiveness of DBS and both pharmacological methods based on continuous drug administration is comparable. Approximately every second patient with advanced Parkinson's disease who requires DBS is not eligible for this form of therapy (due to contraindications) and should be treated with one of the infusion therapies.
Read about infusion therapies
Programming the neurostimulator so that it starts sending electrical impulses,is performed a few hours after the procedure. The stimulation parameters are selected individually for each patient. The higher the pacing parameters, the faster the pacemaker battery will wear out. The batteries in the currently used stimulators last for several years of their operation.
After programming the neurostimulator, the patient feels much better - the tremors disappear, he has no major problems with walking (e.g. he can walk without assistance, e.g.).
Improvement in tremor and stiffness lasts up to 10 years after pacemaker implantation, and in bradykinesia (slowing down) - up to 8-9 years. Also, for a period of 10 years, motor fluctuations and dyskinesias, both dystonic and chorea can be controlled.
Deep brain stimulation - pros and cons
The advantage of the DBS method is the method of pacemaker implantation (i.e. individual elements are placed subcutaneously and inside the skull), as well as the long-term possibility of adjusting the stimulation parameters to the changing picture of the disease.
The disadvantage, however, is the possibility of switching off the stimulator in the magnetic field, which, among other things, limits the performance of certain tests and medical procedures.
Deep brain stimulation - side effects
After pacemaker implantation, there is a risk of bleeding or infection after the procedure. In turn, the side effects resulting from the stimulation are:
- possible speech deterioration
- emotional disorders (depression, hypomania, suicide attempts)
- risk of cognitive decline (mainly in terms of executive functions and verbal fluency)
Monika Majewska A journalist specializing in he alth issues, especially in the areas of medicine, he alth protection and he althy eating. Author of news, guides, interviews with experts and reports. Participant of the largest Polish National Medical Conference "Polish woman in Europe", organized by the "Journalists for He alth" Association, as well as specialist workshops and seminars for journalists organized by the Association.
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