Deep Brain Stimulation for Parkinson Disease: New Chapter in Treatment

To date, more than 150,000 people have received DBS worldwide.

• DBS is an approved treatment by the US FDA for movement disorders (such as Parkinson disease, essential tremor, and dystonia), as well as epilepsy, and obsessive compulsive disorder. Worldwide DBS is most commonly used to treat Parkinson disease in all advanced medical centres.
• DBS is also being studied in clinical trials for use in other conditions such as Alzheimer's disease, depression, chronic pain, stroke recovery, addiction and anorexia nervosa.

Chemical imbalances and abnormal brain networks lead to the disease symptoms. DBS works by using electrical impulses to block or change these abnormal nerve signals and chemicals in the brains.

Simply, very much like how a pacemaker for the heart helps to prompt the heart to beat at a normal rate in people with abnormal heart rhythms, DBS does the same for the brain.

DBS is typically performed on both sides of the brain to control symptoms affecting both sides of the body. Importantly, the effects of DBS are fully reversible and stimulation settings can be programmed to optimise the effect for the individual. DBS provides continuous symptom control 24 hours a day.

Benefits of DBS in Parkinson disease

1. Increase ease of movement
2. Less freezing of gait (feet are less stuck to the ground)
3. Relief from disabling tremor
4. Less dyskinesia (abnormal uncontrolled movement)
5. Reduction in medication usage

In Parkinson disease, all the symptoms that can be improved with levodopa medication will also be improved by DBS. In addition, people have also reported better sleep, better mental well-being, and therefore an overall better quality of life after DBS.

Parkinson disease symptoms (such as tremor, slowness and stiffness) improve immediately after the battery is switched on, while other symptoms such as dyskinesia can take a few weeks to months to get better.

Several programming or tuning sessions are required to fully optimise the stimulation settings. This is done using a wireless remote control. It typically takes 3 to 6 months after DBS surgery for the full benefits to be realized.

DBS should not be thought of as a “last resort”. The goal of surgery is to preserve function, rather than to rescue a person from disability. If you experience disability despite optimal medications, then DBS should be considered.

It is important to understant that there are some symptoms that are less likely to improve with DBS. The symptoms that do not respond at all to levodopa, such as balance and swallowing, usually do not improve with DBS. To address these symptoms, additional therapies such as physiotherapy will be required after DBS. Although DBS can improve symptoms and quality of life, it is not able to return anyone to perfect health.

DBS addresses symptoms but is not a cure. The disease will continue to progress and worsen with time. The good thing about DBS is the stimulation parameters can be adjusted to manage symptoms as they change and develop with the disease over time.

A commonly asked question by patients with Parkinson disease is when they should have DBS procedure. In general, you should consider DBS for Parkinson disease if any of the following statements in the checklist below applies to you:

• Your medication does not last as long as it once did.
• You need to take medication more and more often (increasing dose of medication).
• Your medications fail to kick in or wear off unexpectedly.
• You find it hard to tolerate the side effects from your current medications.
• Your symptoms have become disabling and unresponsive to medications.
• Your symptoms reduce your quality of life or interfere with daily activities.

‍

Try our Quality of Life Questionnaire.

Discover if you should consider DBS based on your current quality of life with Parkinson disease

The DBS battery is also referred to as the implantable pulse generator (IPG). The IPG contains a battery and a power module to create the electrical impulses, a CPU and program memory to store your DBS parameter settings, and a microprocessor to manage the device functions (such as activation, deactivation, and pulsing). Typically, a non-rechargeable battery lasts 4-5 years while the rechargeable battery lasts 15 years.

DBS surgery is considered a safe and effective procedure. Like any surgery, DBS has its risks which include the risk of infection and bleeding in the brain. Your neurosurgeon will discuss the risks in detail with you.

In Singapore, the total cost of deep brain stimulation surgery is calculated based on 3 main factors:

1. Hospitalisation cost
2. Operation cost
3. Implant cost

The cost of hospitalisation depends on the type of bed chosen and also on the length of stay in the hospital. The shorter the length of stay, the lower the cost. Operation cost will depend on whether the surgery needs to be performed on one side or two sides (bilateral) and whether the surgery is performed with the patient asleep under general anaesthesia or awake.

Given the number of variables involved, please speak to your neurosurgeon to get the most updated information regarding the estimated cost of surgery.

Our recent study in patients who had DBS in Singapore showed that for the majority of them, there was a sustained reduction in medication usage for over a decade which can in some cases help offset some of the cost of surgery.

Speak to our neurosurgeon who specialises in DBS to find out more.