Deep Brain Stimulation Provides Life-Changing Results to Parkinson's Patients
Kenneth Follett, MD
It's been called life-changing. Deep brain stimulation (DBS), a procedure that can be likened to a pacemaker for the brain, has become an effective therapy that can provide significant relief of symptoms to patients with severe Parkinson's disease.
Among the early adopters of the procedure, neurosurgeons at The Nebraska Medical Center have been performing the procedure for more than 15 years. "After five to 10 years of medical therapy, medications may start losing their effectiveness and most Parkinson's patients begin to suffer from medication side effects," says Kenneth Follett, MD, PhD, neurosurgeon at The Nebraska Medical Center. "Study results show this procedure doubles the amount of functional time these people have each day."
Dr. Follett, a recognized world leader in the field of DBS, has served on the national advisory panel for Medicare that developed guidelines for DBS.
"It's not a life-saving surgery, per se, but it can have such a dramatic impact on the quality of life of these patients that I personally believe it merits any potential discomfort and risks of surgery," he says. "People don't usually thank their brain surgeon, but I have received many thank yous from patients for doing this procedure."
John Bertoni, MD, PHD
Dr. Follett began performing the DBS procedure when it was FDA-approved in 1997 for treatment of essential tremor. "The results were so significant that it quickly became apparent that it could replace the standard surgery to treat Parkinson's that was in use at that time," says Dr. Follett. DBS was FDA-approved for treatment of Parkinson's in 2002; however, Dr. Follett had already begun performing the procedure for severe cases of Parkinson's in clinical studies. Today, the procedure is considered the gold standard of surgical treatment for Parkinson's disease as well as severe cases of essential tremor and certain types of dystonia.
Deep brain stimulation uses mild electric pulses to disrupt abnormal activity in the areas of the brain thought to be responsible for Parkinson's symptoms or tremor. The surgery entails implanting an insulated wire lead in one of several areas of the brain. The lead is connected to a small pulse generator, like a heart pacemaker, which is implanted beneath the skin in the chest area. This generator can be controlled by the doctor to adjust the frequency and strength of the electrical impulses to fit each patient's needs.
"DBS is effective in nearly all Parkinson's patients and patients with essential tremor provided candidates for the surgery are selected carefully," says Dr. Follett, who works with a team of doctors who are part of the Movement Disorders Clinic at The Nebraska Medical Center. The clinic is one of the most comprehensive, multidisciplinary programs in the region that combines specialists in neurology, neurosurgery, neuropsychology and physical, occupational and speech therapy.
"The results provided by deep brain stimulation are significant," agrees John Bertoni, MD, PhD, a neurologist at The Nebraska Medical Center and director of the Parkinson's Disease Clinic. Dr. Bertoni has dedicated the last 30 years of his practice to treating Parkinson's patients. "Patients with severe symptoms shouldn't wait until the last minute to have this done because it can provide results that last for many years."
To qualify as a good candidate, patients must not suffer from dementia, must have inadequate relief of symptoms with optimal medical therapy sometimes with limiting side effects such as motor fluctuation and dyskinesias, and must get adequate relief from the drug L-dopa.
The procedure has not been around long enough to know how long it will remain effective, says Dr. Follett, but currently, we are seeing patients get good results for 10 years or more.
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