The symptoms shown in the picture above represents Parkinsonism symptoms.
Deep Brain Stimulation for Parkison’s Disease
- DBS is a relatively new procedure that uses an implantable electrode into a specific target in the brain and is attached to a programmable pulse generator.
- The pulse generator is implanted in a pocket below the clavicle and connected to the DBS electrode in the Brain.
- (The pulse generation is just like a cardiac pacemaker but the wire goes to the specific site in the brain)
Principle of DBS in Parkinson’s Disease
- Parkinson’s disease is characterized by loss of dopaminergic input to the striatium, which has been shown to be associated with hyperactivity of two key nuclei within the basal ganglia, namely the subthalamic nucleus and the
- Globus Pallidus Internus.
- Dopaminergic dennervation in PD leads to increased firing of neurons in the STN and GPi resulting in excessive inhibition of the thalamus, reduced activation of the cortical motor systems and development of Parkinsonian Features.
- DBS is believed to reduce the neuronal overactivity of the STN and/or the GPi and thereby improve features of PD.
Specific regions in the brain are targetted by DBS
- There are three brain targets that have been FDA approved for use in Parkinson’s Disease for Deep Brain Stimulation
- Subthalamic nucleus (STN): Most preferred & commonly used target
- Globus pallidus Internus (GPi): Effective target (Results comparable with STN)
- Thalamus (Ventral Intermediate Nucleus): Only effective in relieving Tremor (not preferred anymore)
Indications for DBS (Ideal candidate)
- The procedure is primarily indicated for patients who suffer disability from levodopa induced motor complications that cannot be satisfactorily controlled with drug manipulation.
- Symptoms that improve DBS are essentially the same individual symptoms that improve with levodopa (dopamine) with the exception of medication refractory tremor and dyskinesias.
- DBS provides effective relief from all cardinal dopaminergic motor symptoms including gait, posture and balance.
- Improves tremor, rigidity bradykinesia. It provides dramatic result with respect to “off’ time and dyskinesias but does not improve features that fail to respond to levodopa.
- It does not prevent the development or progression of non-dopaminergic features such as freezing, falling and dementia.
- DBS does not improve cognitive (thinking ability).
- Decrease the dose of medications required (in many but not all cases).