Is DBS for me? - Parkinson's disease
First approved by the FDA for Parkinson’s disease in 2002, deep brain stimulation (DBS) has almost completely replaced previous surgeries to treat Parkinson’s disease. The treatment uses an electric pulse generator, similar to a heart pacemaker, to control the symptoms of Parkinson’s, returning a body organ to its normal operating state. DBS offers many benefits for Parkinson’s disease patients, from fewer tremors to more “on time” to reduced medications. New research shows that DBS is effective in early stages of Parkinson’s disease and may extend your life.
Parkinson’s disease is a disorder of the nervous system that affects movement, muscle control, and balance. The disease affects people of all ages, but most frequently occurs in people aged 55-75. Parkinson’s disease is a progressive condition, meaning symptoms will worsen over time.
The cause of Parkinson’s is not known, but many scientists think the condition is due to a combination of family history and environmental factors. Parkinson’s is more common in men than women, and people with siblings or parents who developed the disease at a younger age are at a higher risk for developing Parkinson’s.
There are many symptoms of Parkinson’s disease, which vary from one individual to another. Almost all patients complain of handwriting that has decreased in size over the years and some patients complain of an abnormal twisting or turning movement of an arm or leg (dystonia). Many symptoms are caused by the disease advancing into areas of the brain that control movement. As with any progressive disease, symptoms begin slowly and in a few places, spreading throughout the body and/or worsening over time.
Tremor is the most common symptom associated with Parkinson’s disease. Typically patients will notice an occasional rhythmic tremor that starts in one finger, eventually spreading to the whole arm. Some patients notice tremors when an arm or leg is resting or in an unsupported position. These tremors can occur on one or both sides of the body. If left untreated, tremors can affect the head, lips, tongue, and feet.
- Slowness of motion, especially when beginning a movement.
- Stooped posture and a slow, shuffling walk. After a number of years, muscles may freeze up, increasing the risk of falls.
- A compromised ability to swallow or digest foods.
- Rigid muscles, often beginning in the legs and neck. This can produce a mask-like or staring appearance when muscles of the face are involved.
- Muscle movements that normally happen automatically (such as blinking) may need to be done consciously.
- Soft voice and slurred speech are two possible speech problems.
Parkinson’s disease can be difficult to diagnose as there is no laboratory or imaging test that can detect the condition. Doctors frequently use a combination of the patient’s medical history along with a neurological exam to diagnose Parkinson’s.
During the physical and neurological exam, you will be asked to sit, stand, walk, and extend your arms. Your body’s responses to this test will help your physician determine if you have Parkinson’s or a similar condition.
Parkinson’s may also be confirmed with a drug challenge test. Your doctor may try prescribing a drug called levodopa (or L-dopa) and monitor your symptoms. If your symptoms improve while taking the drug, Parkinson’s is the likely culprit.
There is no cure for Parkinson’s disease, and no current treatment has proved to change the course of the disease. There are a wide variety of surgical and non-surgical treatment options for improving patient’s quality of life. The goals of treatment are to relieve physical disabilities and balance symptoms with medication side effects.
The treatment plan for Parkinson’s disease is targeted toward each patient and his/her condition. Patients must work closely with their care team and consider all treatment options thoroughly. Some patients respond well to drug therapies while others battle to balance side effects with symptoms.
Despite recent technological advancements, the popular and time-tested course of treatment for Parkinson’s disease begins with medications. Most Parkinson’s patients have periods of time where the medications are “on” and when the medications are “off.” DBS can typically make every moment as good as when the medications are “on.”