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Deep Brain Stimulation Benefits People with Parkinsonís 10 Years after Surgery

Deep brain stimulation (DBS), already known to improve motor function in some people with Parkinson’s disease (PD) is reported in the August 8 issue of Archives in Neurology to improve some Parkinson’s symptoms 10 years after surgery.

Deep brain stimulation is an established advanced treatment for people within Parkinson’s who experience disabling and uncontrollable tremor, wearing off motor spells, and dyskinesias.  The technique involves the surgical insertion of tiny electrodes deep into the basal ganglia region of the brain and the implantation of an impulse generator or IPG (similar to a pacemaker) under the collarbone to provide an electrical impulse to the brain. Those who undergo the surgery are given a controller, which allows them to check the battery and to turn the device on or off. 

For people with Parkinson’s considering DBS, a critical question is: “How long will the benefit last?’  Elena Moro, M.D., Ph.D., at Toronto Western Hospital and her colleagues provide a partial answer.  Their study provides detailed 10-year follow-up information on a group of 18 people with Parkinson’s who underwent bilateral subthalamic nucleus stimulation, the most commonly performed DBS surgery.  Dr. Moro and her team evaluated motor scores of these individuals before surgery (baseline) and one, five and 10 years after surgery.

Results:

  • At the 10-year follow-up, participants who underwent DBS scored better in total motor function, with or without medication, than when their DBS device was turned off.
  • DBS provided significant reductions in tremor and slowness and improvements in motor fluctuations, dyskinesias and quality of life.
  • The amount of dopaminergic drugs taken by people on a daily basis was significantly less at 10 years than before DBS surgery.
  • When the researchers compared the individuals’ motor scores at one, five and 10 years, they found that the beneficial effects of DBS declined over time.
  • Posture, gait and balance were not improved at the 10-year follow-up.
  • Some individuals in the study who underwent DBS experienced side effects such as weight loss, impulse control disorders and visual hallucinations.

What Does it Mean?

For people with Parkinson’s considering DBS, this study provides optimism that this invasive treatment will produce long-lasting benefits, although the effectiveness of the treatment for some symptoms declines with time.  On average, DBS allowed people with Parkinson’s to reduce their dose of dopaminergic medications to avoid unpleasant side effects, such as dyskinesia.

However, as the researchers note, the study really provides a best-case scenario for DBS outcome because it selected the youngest individuals most likely to have the best result. DBS also is not for everyone.  The procedure probably will not help those with atypical Parkinson’s, poor response to medication, severe medical problems, or depression.

Although DBS cannot cure Parkinson’s, it can improve quality of life and has been shown in randomized clinical trials to be superior to the best medical management in individuals who experience wearing off and dyskinesias. 

Reference: Castrioto, A., Lozano, A. M., Poon, Y.-Y., Lang, A. E., Fallis, M., & Moro, E. (2011). Ten-Year Outcome of Subthalamic Stimulation in Parkinson Disease: A Blinded Evaluation. Archives of Neurology. doi:10.1001/archneurol.2011.182

Source Date: Sep 29 2011