Is Deep Brain Stimulation a Last Resort Treatment for Parkinson’s Disease?

July 3, 2023 | Raquel Paz Bergia | Neurology

Deep brain stimulation (DBS) is a surgical therapy employed to address specific aspects of Parkinson’s Disease. This highly effective treatment primarily targets the movement symptoms associated with Parkinson’s, but why is it only allowed when patients have been diagnosed with PD for over four years?

The U.S. Food and Drug Administration, commonly known as the FDA, restricts the use of DBS for patients who have had PD for at least four years and have motor symptoms not adequately controlled with medication.

But, what is DBS exactly and how does it work?

The Parkinson’s Foundation explains the process by stating that, “In DBS surgery, electrodes are inserted into a targeted area of the brain, using MRI (magnetic resonance imaging) and, at times, recordings of brain cell activity during the procedure. A second procedure is performed to implant an impulse generator battery (called an IPG), which is similar to a heart pacemaker and approximately the size of a stopwatch.

The IPG is placed under the collarbone or in the abdomen and delivers electrical stimulation to targeted areas in the brain that control movement. Those who undergo DBS surgery are given a controller to turn the device on or off and review basic parameters such as battery life.”

The image shown above is an example of an IPG that is implanted to deliver the electrodes mentioned by the Parkinson’s Foundation. Now, these electric signals are not delivered to random places in the brain, they target certain regions.

DBS targeted to the Subthalamic Nucleus is most commonly used to address the motor symptoms of PD. By lesioning the STN, it is abolishing pathological hyperactivity, which is one of the predominant causes of the motor symptoms of PD. 

The other region that tends to be targeted is the Globus Pallidus Pars Interna, which is known as the GPi. However, this form of treatment is only used for certain cases, as there isn’t as much success as when the STN is targeted. 

The video below went viral on TikTok as a doctor explained how fascinating DBS is and how it truly changes the lives of PD patients. Dr. Joe, MD, is an Emergency Medicine Doctor and uses his social media platforms with over 1.5 million followers to educate people about the medical world. 

Now, the big question is, was DBS the last resort treatment for this patient?

Before considering DBS, individuals with PD usually try various medications and other non-surgical interventions to manage their symptoms. These may include levodopa, dopamine agonists, MAO-B inhibitors, COMT inhibitors, and other treatments aimed at improving motor function and reducing symptoms.

If medications become less effective over time or if patients experience adverse side effects, DBS may be considered as an option.

While DBS can be highly beneficial for many people with PD, it is not suitable or necessary for all patients. Some individuals may find adequate symptom relief through medications and other non-surgical interventions, while others may have contraindications for surgery or have specific medical conditions that make DBS less favorable.

Therefore, leading to the conclusion that there are several treatment options for PD patients before trying Deep Brain Stimulation. It tends to be a “last resort” treatment as it comes after years and years of suffering, medical appointments, treatments, and symptoms.