Deep Brain Stimulation for Movement Disorders: Improved Quality of Life, Less Medication.

Medications for movement disorders can help patients regain control of motor symptoms such as tremors, rigidity, and slowness. Yet for some patients, these medications can become less effective over time, and many take their pills several times a day to control symptoms. 

Deep brain stimulation (DBS) is an advanced, lasting treatment to manage motor symptoms.

While DBS does not treat cognitive symptoms, many patients with Parkinson’s disease, essential tremor, and dystonia can regain control of their movements and reduce their medications.

DBS is a two-step brain procedure that involves installation and activation of a device that emits controlled electrical stimulation to the basal ganglia—an area of the brain that drives motor function. The Food and Drug Administration first approved DBS for treatment of essential tremor and tremor associated with Parkinson’s disease in 1997.

Researchers have found a 26% improvement in quality-of-life scores after DBS, compared to a 1% decline for patients on medication only. DBS can help patients regain the ability to complete daily activities, provide more symptom-free time, and lead to fewer medication side effects by reducing doses.  

“Deep brain stimulation has completely changed movement disorder treatment,” said Fernando Luis Pagan, MD, a neurologist who specializes in movement disorders at MedStar Georgetown University Hospital. “It can make a huge impact in the quality of life for many patients.”

DBS isn’t a cure for movement disorders; patients still need medications to control other non-motor symptoms. But this precise, adjustable technology offers patients hope for better control with less medication.

Deep brain stimulation: More control, fewer side effects.

Patients who choose deep brain stimulation are treated by a team of experts. That’s part of the reason why MedStar Health is a Parkinson’s Foundation Center of Excellence, one of only 40 medical centers recognized for exceptionally high-quality care.

“You’ll see a neurologist, neurosurgeon, neuropsychologist, and other specialists,” explained Gary Volkell, DO, a neurologist and movement disorder specialist at MedStar Franklin Square Medical Center. “DBS involves a big team, and it always includes you, the patient. We make the best decisions when our team includes multiple specialists, the patient, and their caregivers.”

Step 1: Installation.

First, surgeons implant electrodes in the patient’s brain. Patients are asleep under anesthesia for this procedure. Surgeons are guided by intraoperative MRI, an important and unique advance that allows them to visualize precisely where each electrode should be placed for optimal results while minimizing damage to surrounding brain tissues.

“DBS is a compassionate surgery,” Dr. Pagan explained. “Intraoperative MRI has made these procedures dramatically more precise, with fewer side effects.”

Patients stay in the hospital one night after the electrode implant surgery for monitoring.  One week later, they return for a second surgery to implant a device called an implantable pulse generator, or IPG, beneath the clavicle. 

Step 2: Activation and programming.

After these surgeries, the neurologist will turn on and program the device to deliver electrical stimulation to the target area. This area at the center of the brain relays sensory and motor information to the cerebral cortex, which is the outer layer of the brain where motor functions are carried out. 

The stimulation helps regulate brain activity and reduce symptoms. Additional adjustments are made over time to fine-tune movement control. Most patients see quality of life improvements right away and maximum benefit after three to six months.

Before DBS, neurosurgeons used a surgical process called thalamotomy or pallidotomy to treat movement disorders. The procedure involved making a lesion in the basal ganglia, and while effective short-term, it was irreversible and often only offered six months of symptom improvement. DBS is a more targeted and adjustable treatment option. 

“With DBS, you can turn the device off and it’s like you never had the surgery,” said Dr. Volkell.

Often, a patient’s medications can be reduced by 30-60% after DBS surgery. Research has shown that DBS provides better movement control than medication alone. One study showed motor scores for patients with Parkinson’s disease improved 4% over two years while on medication; patients with DBS showed a 53% improvement in the same scores.

Who is a candidate for deep brain stimulation?

Patients with a movement disorder such as Parkinson’s disease, essential tremor or dystonia whose symptoms are not well controlled by medication could be candidates for DBS. Medications can provide some relief for patients with movement disorders, but dosing can be tricky. For instance, Carbidopa/Levodopa can help patients with Parkinson’s disease, but too much of the medication can lead to excessive movements, called dyskinesia.

For patients with essential tremor or dystonia, that could mean difficulty writing, eating, or getting dressed. Patients with Parkinson’s disease may notice the effects of their medication don’t last long, or they may experience dyskinesia.

“It’s like walking a tightrope,” said Dr. Volkell. “It’s important to make sure the dosage is correct for each individual patient.”

To ensure a patient is a good candidate for DBS, we conduct thorough tests, including:

• On/off testing: Patients who respond well to DBS typically also respond to medication. We test patients’ motor control before and after a dose of Levodopa/Carbidopa. Patients with at least a 40% reduction in their motor testing are likely to have good results after DBS.

• Neuropsychological testing: Patients with dementia or psychosis are not eligible because DBS can sometimes worsen symptoms of these conditions.

Related reading: Understanding Parkinson’s Disease: Symptoms, Diagnosis, and Treatment for the Common Movement Disorder.

Research explores tomorrow’s treatments.

DBS provides many patients with major quality of life improvements, but it’s not a cure for movement disorders. We’re excited about several important studies underway now that could help our patients even more. For example:
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• We’re involved in an early study of an mRNA treatment that has shown dramatic improvements in motor function for patients with Parkinson’s disease. A national placebo-controlled study of this treatment is now underway. 

• Another related study is examining the use of stem cells to stimulate the production of a nerve growth factor that is missing in patients with Parkinson’s disease.

• We’re continuing our decade-long exploration of a drug that has shown improvement for patients with dementia with Lewy bodies. We hope to launch a national study of this treatment soon.

  Several studies are underway to identify new, longer-lasting medications to treat dyskinesia and to examine the benefits of combined mRNA and DBS treatments.

“There’s a lot of new technology, and a lot of newer medications that have recently been approved by the FDA,” Pagan explained. “There’s excitement that we can continue to make meaningful quality of life improvements for people with movement disorders.”

DBS stimulation is brain surgery, which can be an intimidating decision for patients. Yet with multidisciplinary teams of experts and advanced technology such as intraoperative MRI—which allows surgeons to perform the procedure while patients are under general anesthesia—deep brain stimulation is making a real difference for patients with movement disorders.