Deep brain stimulation (DBS) is a surgical procedure for Parkinson's that can treat movement symptoms, such as tremor, slowness and stiffness, and decrease medication needs. Many people with Parkinson's wonder if and when they should consider DBS. Like any other therapy, it's not right for everyone. And there is no strictly defined window of time during which someone can or should undergo DBS. In the right candidate, it can provide significant symptom relief, so you may want to start thinking about DBS if medication works but causes complications such as dyskinesia and "off" time.
The Basics of Deep Brain Stimulation
DBS delivers small pulses of electrical stimulation to specific areas of the brain to lessen Parkinson's symptoms. DBS systems have three main components:
- Lead: This is a wire surgically implanted into the area of the brain that causes abnormal movement. Electrical stimulation flows to the brain through the lead and one lead typically is placed in each side of the brain (some people only get one lead on one side).
- Implantable pulse generator (IPG): Also called the neurostimulator, the IPG, which usually is surgically placed below the collarbone, is the system's battery and "brains." Your doctor programs the IPG to deliver the right amount of electrical stimulation for you and your symptoms.
- Extension wire: This wire connects the lead(s) to the IPG.
DBS was U.S. Food and Drug Administration (FDA)-approved for Parkinson's tremor in 1997 and then for other Parkinson's symptoms in 2002. For many years, Medtronic was the only maker of DBS devices in the United States. But in the last few years, two additional DBS devices -- the Abbott/St. Jude Infinity and Boston Scientific Vercise -- have gained approval.
Considerations when Choosing a DBS System
Many people wonder what the differences are between these systems and which is best for them. All DBS devices have the same basic components and work the same way. But slight variations in the components and capabilities, such as rechargeable batteries and leads that deliver electrical stimulation in varied ways, might lead your doctor and you to pick one over another. When thinking about DBS systems, consider:
- If you want a rechargeable battery
Rechargeable batteries (offered by Medtronic and Boston Scientific) can last up to 15 years, which may mean fewer surgical procedures to replace them. Non-rechargeable batteries last, on average, for three to five years. (Battery life depends on your individual settings.) But rechargeable batteries may require daily or weekly recharging. Would you prefer the regular recharging on your own or the outpatient surgeries every few years for battery replacements?
- Whether you will need regular MRIs
Medtronic and Abbott DBS are MRI "conditional," meaning that these devices are safe for MRI provided that certain conditions (using a specific type of MRI scanner with DBS off or programmed to different settings, for example) are met. Think about your medical conditions and whether any, such as spine problems, require regular imaging.
- How the surgical procedure will be performed
Surgeons traditionally implant brain leads while a person is awake so that they can be sure the leads are in the right spot and not causing side effects. But some centers do DBS under general anesthesia with MRI guidance. Choosing this "asleep DBS" could impact which device your doctor recommends or uses.
- What system your movement disorder specialist and surgeon prefer
Your personal physicians likely have more experience or comfort with certain devices. The ease of lead placement or ability to program in specific ways, for example, could direct them to choose one over another. Today's systems differ mainly with regard to how the leads are built and deliver electrical stimulation to the brain. St. Jude and Vercise leads may allow more flexibility in programming to potentially hone stimulation and lessen side effects. But doctors have been using Medtronic devices for decades. Since the systems haven't been compared head-to-head in a clinical trial, it's unclear if one works better than another.
- Your level of interaction with the device
Some people want to change DBS settings (within certain parameters set by their physician) on their own. Others don't want to alter settings outside of doctor's visits. For those who adjust the device regularly, some programmers (such as the St. Jude, which operates through Apple digital devices) may be easier to use.
Where DBS Research Is Heading
More DBS devices not only give more treatment options, they spur competition and innovation. Researchers are working on the next generation of devices -- ones that could even program or adjust stimulation on their own in response to an individual's brain signals and symptoms. And while we work toward those upgraded types of DBS, The Michael J. Fox Foundation is creating a DBS registry to collect information on all aspects of DBS: who gets which DBS system in what part of the brain to target which symptoms, what settings are programmed and how people do over time. This database will help direct doctors and patients to more informed and focused decisions around DBS patient, device and setting selections for improved benefit.