Dr Tom Foltynie
Consultant neurologist, National Hospital for Neurology and Neurosurgery, London
Consultant neurologist, Dr Tom Foltynie, from the National Hospital for Neurology and Neurosurgery, London, discusses deep brain stimulation (DBS).
What is DBS and what does it involve?
It’s a type of surgery used for movement disorders like Parkinson’s disease (PD), essential tremor and dystonia (a condition that causes involuntary muscle contractions). It involves placing electrodes in the brain and connecting them, through wires that run under the skin, to a battery-powered pacemaker implanted under the skin on the chest wall. The electrodes deliver mild electrical impulses that help control symptoms. Patients with PD respond well to drugs, but the effect lasts only a short time. DBS can mimic the benefits of drugs 24 hours a day, seven days a week.
Who is DBS for and what benefits can they expect?
The procedure is for patients who respond well to drugs but have unpredictable fluctuations between good and poor symptom control. In PD it can help improve tremor, slow movement, rigidity and pain, for many years. However, it doesn’t slow down the disease progression.. So, over time, people can develop new symptoms that make it harder to provide good quality of life. This is not because the device stops working, but because the disease is progressing.
Are there risks associated with DBS treatment?
There are very small, but real, risks associated with having electrodes inserted into the brain. One of these is bleeding, which can cause a stroke. There are also small risks associated with the electrical stimulation, such as slurred speech. It is important to select patients very carefully, so that the benefits of the treatment justify the small risks, and that these risks are minimised.
What have been important advances in DBS treatment recently?
One of the most exciting recent advances is that we can now use magnetic resonance imaging (MRI)- although only in highly controlled settings- as a research tool to see how different brain areas increase or reduce their activity during DBS.
This was unthinkable before, and opens up the possibility for applications beyond the field of movement disorders.
In addition, patients with DBS developing other problems, for example a prolapse disc, can now potentially have an MRI scan, whereas previosuly having a DBS device would have been a reason not to do so. However, this can be done only under very strict conditions, following specific guidelines, by clinicians with the right level of expertise. Its not something patients can do without appropriate safety precautions.
If you would like to know more about this treatment, please consult your GP.