Pros and Cons of Deep Brain Stimulation

Procedure Aims Correct Side Effect of Parkinson's Therapy

CT Brain Scans
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Deep brain stimulation (DBS) is a surgical procedure which implants an electronic stimulator into the brain to treat some of the more serious side effects of levodopa therapy. Levodopa therapy involves the use of a class of drugs called dopamine agonists which can improve the symptoms of Parkinson's disease but lead to adverse conditions in some.

One the more concerning complications is dyskinesia, a neuromotor disorder which involves the painful, involuntary, and spasmodic movements of the hands, trunk, and legs.

 While most cases can be treated by adjusting the levodopa dosage, the problem can sometimes persist even after treatment is stopped. This is when surgical options may help.

How Deep Brain Stimulation Works

DBS involves the implantation of an electrical stimulator into either the subthalamic nucleus of the brain or a section of the Globus Pallidus (GPi). These brain sites play crucial roles in regulating movement.

To treat dyskinesia, a battery-operated neurotransmitter about the size of a stopwatch is implanted beneath the skin near the collarbone. A wire inserted into the brain can then respond to brain signals and regulate any abnormalities in movement that may occur.

Once the surgery is completed, the individual can control the level of stimulation, gauging and adjusting the response as needed.

The main advantage of DBS is the striking improvement in levodopa-associated dyskinesia in most case.

Furthermore, the implantation of the device does not cause damage to the brain or the formation of cerebral lesions. Other side effects tend to be minimal, particularly when implanted into the GPi.

Risks of Deep Brain Stimulation

DBS procedures carry some risks. After all, it is a surgical procedure involving the opening of the scalp and the implantation of an electronic device deep into the brain.

Not only are there risks that need to be considered, there are limitations as to what the device can and cannot do.

Among the concerns:

  • DBS does not appear to increase the benefits of levodopa therapy. The primary aim of DBS surgery is to minimize dyskinesia rather than relieve the symptoms of Parkinson's.
  • Side effects can include pain, swelling at the surgery site, and infection. Less commonly, a brain hemorrhage or stroke can occur.
  • Some people report a persistent tingling (neuropathy) of the face soon after surgery, as well a noticeable dizziness, loss of balance, and reduced coordination. Many of these effects resolve over time without medical intervention.
  • In rare cases, there can be also an allergic reaction to implant itself.
  • Regular monitoring of the device is needed along with the periodic changes of batteries.

A Word From Verywell

If you are experiencing painful and uncontrollable dyskinesia, discuss the option of DBS with your doctor as well as non-surgical alternatives that may help. People experiencing dyskinesias can sometimes lessen the severity of symptoms by switching from oral medications to a continuous delivery system (such as enteral infusions which pump a gel form of levodopa directly into the stomach).

Source:

Olanow, C.; Stern, M.; and Sethi, K. "The scientific and clinical basis for the treatment of Parkinson disease." Neurology. 2009; 72(21 Supplement 4):S1-136. 

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