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Deep Brain Stimulation Improves Driving
- Jan 17 2014
Deep brain stimulation (DBS) may improve the driving ability of people with Parkinson’s disease (PD), according to a new study in the journal Neurology published online December 18. In a driving simulation test, people with DBS performed similarly to people without PD.
While many people can drive safely long after a PD diagnosis, for some, the symptoms of disease and side effects of medications make safe driving a problem. Researchers wanted to know whether DBS – a surgical treatment that controls Parkinson’s symptoms by delivering a small electric current to structures of the brain – could impact driving ability. On the one hand, researchers theorized that DBS might enhance driving ability by improving motor symptoms of PD. On the other hand, they knew of evidence suggesting that DBS impairs cognitive functioning and impulse control, which might worsen driving.
Scientists led by Carsten Buhmann, M.D., at the University Medical Center Hamburg-Eppendorf, in Germany, used a driving simulator, to compare driving performance of 23 people with PD who had DBS (in a region of the brain called the subthalamic nucleus), 21 people with PD who did not have DBS, and a control group of 21 healthy volunteers.
The driving simulator tested the ability of the participants to respond to typical urban traffic situations, such as having to turn at street crossings, stay within their lane, follow signs and handle traffic lights. The people in the DBS group were asked to complete the driving test under three different conditions: 1) with their DBS stimulator switched on; 2) with their DBS stimulator switched off; and 3) with their DBS stimulator switched off, and right after taking extra levodopa, the gold-standard drug for PD (to make up for the DBS stimulator being turned off).
- People with DBS drove just as safely as the healthy controls without PD and more safely than people with PD without DBS.
- People with Parkinson’s without DBS drove less accurately and with more errors than people with DBS or healthy controls.
- People with DBS drove more slowly than people without DBS and healthy controls, taking about one and a half minutes more to finish the one-mile course.
- People with DBS drove more safely when the DBS stimulator was turned on than when it was turned off, regardless of whether they had taken levodopa.
What Does It Mean?
This study demonstrates that DBS may have a beneficial effect on driving in people with PD, and perhaps a more beneficial effect than levodopa alone.
However, more research is needed to confirm these findings and to understand them. For example, people with DBS tended to drive more slowly and with fewer errors than those without DBS. Researchers suggest this may indicate more caution.
Additionally, people with DBS drove better when their stimulators were turned on than when they were turned off, regardless of whether they had taken levodopa to compensate. Because DBS and extra levodopa improved motor symptoms to a similar level, the researchers hypothesize that DBS might improve non-motor aspects of PD that lead to better driving. However, there is no evidence of this yet.
The driving test used in this study was short (one-mile) but it involved demanding, inner-city or neighborhood driving conditions. It is possible that driving longer distances may be more difficult for people with PD, since some people experience difficulty paying attention for longer periods of time. Therefore, future studies should address longer-distance driving. Lastly, this study compared different people with and without DBS. In order to prove that indeed it was the DBS that improved participants’ driving skills, it is important to compare people with PD before and after they undergo DBS surgery.
Driving is critical to quality of life and independence. However, for people with Parkinson’s who experience certain symptoms and side effects, including slowed reflexes and decreased dexterity with their movements, driving may become a risk for themselves and others. The decision of whether a person with PD can drive safely should be evaluated individually, taking into account the person’s cognitive, visual and motor abilities and state law. For additional information and tips, please see PDF’s webinar below.
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Reference: Buhmann C, Maintz L, Hierling J, Vettorazzi E, Moll CKE, Engel AK, Gerloff C, Hamel W, Zangemeister WH (2013) Effect of subthalamic nucleus deep brain stimulation on driving in Parkinson disease. Neurology. DOI: 10.1212/01.wnl.0000438223.17976.fb http://dx.doi.org/10.1212/01.wnl.0000438223.17976.fb
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Source Date: Jan 17 2014