Fortunately, there are an increasing number of treatment options for patients with Parkinson’s disease. Most of the medication targets the brain’s dopamine system and aim to supplement or enhance the decline in available dopamine. These dopaminergic medications are often used in combination with other types of medications that can target symptoms that may also occur in some patients, such as depression, sleeping troubles, constipation and other Parkinson’s-associated issues. While very effective, some of these anti-Parkinson’s medications, like most medications, have potential side effects and should be reviewed with you by your treating movement disorder specialist.

Medical Treatments

When patients are diagnosed with Parkinson's disease, they are usually treated initially with a number of different medications in an attempt to control some or all of the symptoms associated with the disease. One of the most commonly used medications is levodopa (Sinemet) — which can partially replace the neurotransmitter known as dopamine — an essential chemical in the brain which is deficient in Parkinson’s disease.

Many of these medications are quite effective in treating these symptoms, however, they may lose their effectiveness or have untoward side effects such as severe dyskinesias (abnormal movements). Additionally, patients can suffer from severe on/off motor fluctuations over time. Since Parkinson’s is a progressive disease, medications which may have been effective for quite a long period of time may become less effective as the disease progresses.

Surgical Treatments

Patients with significant disability despite optimization of their medical regimen may be candidates for Deep Brain Stimulation (DBS). DBS is a procedure in which tiny electrodes are placed into the brain with the help of computer guidance. These electrodes are connected to pacemaker-like devices implanted beneath the collarbone, much like a cardiac pacemaker. Continuous electrical stimulation effectively jams or blocks the abnormal circuitry of the brain that occurs in disorders like Parkinson’s disease, essential tremor, dystonia and other conditions. The result is an improvement of many of the most disabling symptoms, which can lead to an improved quality of life for patients suffering from these diseases.

The surgery is performed in two stages:

• Stage one: implantation of the electrodes in the brain. This typically requires a two to three day hospital stay.
• Stage two: placement of the pulse generators, or brain pacemakers, is performed seven to ten days after the first surgery.  This is typically performed as an outpatient.

In the week prior to the surgery, the patient will undergo presurgical testing that will include routine blood tests and a high-resolution brain MRI scan. At the time of the procedure a halo-like frame known as a stereotactic headframe will be placed on the patient’s head and a CT scan will be performed. The CT scan information will be transferred to a computer where it will be merged with the previous MRI scan and the target will be identified.

Once in the operating room, the patient will be placed under local anesthesia, a small access hole will be made in their skull and an electrode will be placed into the brain using computer guidance. Using sophisticated monitoring devices, the operating room team will listen to the activity of the neurons, or nerve cells, in the brain to determine precisely where to place the electrode.  If the patient is undergoing a bilateral procedure, the procedure is then repeated on the other side. Once both electrodes have been placed, they are left under the scalp and the surgery is complete.

In Stage 2, the generator (pacemaker) devices are placed under the skin near the collarbone, and connected to the electrodes with extension wires. The surgery takes approximately two hours.

The generator is not usually activated until a few weeks after the procedure when all the wounds have healed. Nevertheless, just placing the electrode in the correct location can result in a temporary improvement in some of the symptoms.

Our movement disorder team will activate the generators and determine the optimal settings to obtain the maximum clinical benefit with minimal side effects. Over the first few months, the patient may need a number of adjustments in order to determine the best settings. Once the optimal settings have been determined, the patient can turn stimulation on and off with a small remote control. For example, some patients turn the generator off at bedtime.

Battery longevity varies depending on the parameter settings and number of hours the pulse generator is turned on each day. Estimated battery life is about four years at typical settings. When the pulse generator battery needs to be replaced, the old pulse generator is replaced by an entirely new one and the extension and lead are not replaced so there is no further brain surgery involved. The replacement procedure can be done under local anesthesia.

DBS is a very safe and effective surgical procedure. Nevertheless, like any surgery, there are a number of potential risks. The potential risks or discomforts include: 

• Bleeding, infection or other damage to the brain or its surrounding structures;
• Malfunction of the system which may require replacement or removal of the device;
• Temporary side effects from stimulation that can be alleviated by changing the stimulator settings.
  

It is important to keep in mind that currently, there is no cure for Parkinson’s disease, essential tremor or dystonia. The goal of this surgery is to improve your quality of life by minimizing some of the disabling symptoms of the disease. The effects of DBS are reversible — when the stimulation is turned off, the symptoms will eventually reappear. On the other hand, the latest publications have demonstrated that the beneficial effects continue for years following surgery.

Recent studies have demonstrated that DBS may be effective in treating other conditions such as Tourette's syndrome, depression, and obsessive-compulsive disorder. DBS has been used for many years to treat chronic pain not relieved by other treatments.


Functional and Restorative Neurosurgery
865 Northern Boulevard
Great Neck, NY 11021
(516) 570-4430