Developed in the 1980s, DBS is a proven therapy that can reduce some of the most debilitating motor symptoms associated with three of the most prevalent movement disorders:
- Parkinson's disease
- Essential tremor
The Federal Drug Administration approved DBS as a treatment for essential tremor in 1997; for Parkinson's in 2002; and for dystonia in 2003. To date, more than 100,000 patients worldwide, who experienced insufficient relief with medications and other non-surgical treatments, have benefited from DBS.
An adjustable and reversible treatment for motor symptoms of movement disorders, DBS offers patients greater freedom to live and work. It can dramatically enhance quality of life for people with Parkinson's and essential tremor through improved motor control, mobility and functional ability.
Why Choose St. Luke's for DBS?
- Expertise. St. Luke's is nationally recognized in neurology and neurosurgery by U.S. News & World Report. Patients also benefit from St. Luke's affiliation with Baylor College of Medicine, a leading medical school with extensive experience with DBS. The St. Luke's team includes a fellowship-trained neurosurgeon, who specializes in DBS, and specially-trained movement disorder neurologists, psychologists and psychiatrists.
- Latest technology. St. Luke's is among the first hospitals to add the BodyTom® intraoperative computed tomography (CT) imaging. This technology allows the neurosurgeon to determine in real-time, while the patient is in the operating room, that DBS electrodes have been accurately placed. St. Luke's also has the most advanced 3T MRI imaging to accurately visualize and implant the DBS electrodes.
- Teamwork. St. Luke's interdisciplinary team of medical specialists – which includes a specially trained neurosurgeon, a neurologist, a neuropsychologist and a psychiatrist – evaluates and cares for patients before and after surgery. This team regularly meets to review candidates for DBS, an approach that has led to low complication rates for the procedure.
- Research. St. Luke's collaborates with biomedical engineers at the University of Houston to optimize both placement of the DBS electrodes and programming of the neurostimulator.
The DBS system consists of both implanted and external components and includes the:
- DBS lead – A thin, insulated, coiled wire with four electrodes at the tip is implanted in the brain, with the electrodes placed in the area targeted for stimulation.
- Neurostimulator – A small, sealed, box-like apparatus composed of a battery and electronics is implanted under the skin in the chest and generates electrical pulses discharged through one or more of the electrodes.
- Extension – Also a thin, insulated, coiled wire that is threaded under the skin of the head and neck and connected to the lead at the top of the skull and to the neurostimulator in the chest.
The DBS procedure is divided into two parts:
- implantation of the lead(s)
- implantation of the neurostimulator(s) and extension(s)
The procedure typically takes several hours, although the length and exact steps vary with each patient. At St. Luke's, the two parts of the procedure generally are completed as two separate surgeries, although, under certain circumstances, the two stages can be completed in the same day. Though typically the DBS surgery is performed with the patient awake to enable testing of the electrodes during surgery, the intraoperative CT scanner makes performing the surgery under general anesthesia a safe option for patients who do not wish to be awake during the surgery.
Stimulation may be applied to one or both sides of the brain based on the patient's condition and motor symptoms. Two leads and two extensions―a set for each side of the brain―are needed for bilateral stimulation, which can be delivered through a single battery.
After the surgery, a neurologist programs and adjusts the stimulation settings to maximize control of symptoms and to minimize side effects. The settings – pulse width, frequency and amplitude – can be adjusted for changes in symptoms over time.
After DBS, a handheld programmer allows the patient to control the stimulator within the range of settings established by the physician.
Ideal DBS Candidates
DBS may be an option for people with Parkinson's if they:
- have responded well to the drug levodopa;
- still benefit from medication, despite it's becoming less effective or causing unbearable side effects; and
- require more than one drug, or require doses more often to handle symptoms.
Patients with Parkinson's should be evaluated for DBS as soon as medications begin to lose effectiveness, because the "window of opportunity" closes when medications no longer impact symptoms.
Research has shown that DBS can lessen several motor symptoms of Parkinson's, including:
- rigidity-stiffness or inflexibility of limbs or joints;
- bradykinesia, akinesia-slowness of movement, absence of movement; and
- tremor-involuntary, rhythmic shaking of a limb, the head, or the entire body.
Specifically, studies have shown that DBS:
- Increases periods of good mobility, in which patients had no symptoms or no involuntary excessive movements, from a baseline of 27 percent to 74 percent of the waking day of patients.
- Maintained motor symptom improvements even after five years.
- Reduced several symptoms of Parkinson's and some drug side effects when used in conjunction with medication, as compared to medications alone
DBS has been demonstrated to lessen severity of tremor associated with essential tremor in an upper extremity of the body and shown to improve activities of daily living at 12 months that previously were difficult or impossible for patients.
Also tremors associated with essential tremor lessen and may be an option for patients who:
- have tremors that disturb daily activities, including eating, dressing or writing;
- are unable to work because of tremors; and
- experience tremors that do not respond to medications or for whom medications cause such side effects as sleepiness, dizziness or cognitive problems.
For patients who have primary dystonia, DBS may manage some symptoms, such as muscle spasms, twisting, involuntary contractions, posturing and uncontrolled movements. It also may be considered for patients who have:
- chronic, primary dystonia, including generalized and segmental dystonia, hemidystonia, and cervical dystonia (torticollis);
- minimal success managing symptoms with medication; and
- are at least seven years old.
Obsessive Compulsive Disorder (OCD)
The team at St. Luke's was the first in the Southwestern U.S. to implant a patient with DBS for OCD. This therapy is FDA-approved as a Humanitarian Use Device (HUD) and can be considered for patients with severe OCD who have not improved after multimodal therapy.
As with any surgery, implantation involves some risks. Bleeding in the brain during placement of the lead, and infection are the primary risks. Bleeding in the brain can lead to stroke, and in rare cases, even death.
Precautions for DBS Patients
Patients who have deep brain stimulators must avoid:
- magnetic resonance imaging (MRI) that uses a full body coil or a head transmit coil extending over the chest and
- diathermy, a deep-heat treatment using high-frequency currents.
Additionally, ultrasound, radiation, electrocautery and electrolysis should not be used directly over the location of the implant. It also is advisable to avoid theft detectors and airport security devices.
Insurance Coverage for DBS
Most insurance companies and Medicare cover DBS surgery. In some cases, insurers may deny payment for DBS for dystonia. Although DBS is not a standard dystonia treatment, the FDA has designated DBS as a Humanitarian Use Device (HUD) for certain types of dystonia. A HUD is intended to help in the treatment or diagnosis of diseases or conditions affecting fewer than 4,000 people in the nation each year.