Deep Brain Stimulation
Surgical Treatment for Essential Tremor and Parkinson's Disease
For many patients with Essential Tremor or Parkinson’s disease, deep brain stimulation treatment may offer the best hope for:
- restoring or maintaining the ability to perform activities of everyday life
- gaining more daily hours of symptom relief and good motor function
Deep brain stimulation is a surgical option for patients whose symptoms are not sufficiently controlled by medications. Electrodes are implanted in the patient’s brain, at the precise location where nerve signals generate the tremors. These electrodes are then connected via an extension wire to a neurostimulator, which is implanted just under the skin below the patient’s collarbone.
The neurostimulator, also called an impulse generator or pacemaker, sends tiny electrical impulses through the wire into the brain to block the abnormal activity that causes the tremors. The amount of stimulation is programmed for the patient, and can be adjusted as their condition changes over time.
MidMichigan Medical Center - Midland, a statewide leader in neurosciences, is the only provider in the Midland, Bay City and Saginaw area of Michigan that offers this “pacemaker technology for the brain.”
A Multi-Stage Process
Deep brain stimulation is a multi-stage process that requires a commitment to ongoing follow-up care. The phases and timing will vary for each unique situation, but a typical process includes these steps:
Evaluation, diagnosis and screening
MidMichigan neurologists, neurosurgeons and other experts examine the patient and use diagnostic tests to confirm the diagnosis and whether the patient is a good candidate for deep brain stimulation.
Surgery to implant the leads
One or two leads, each with four 1.5 millimeter electrodes, are implanted into the patient’s brain. The patient is awake during this procedure, which usually takes three to four hours, but may take as many as eight. Because of the unique nature of the human brain, the patient does not feel any pain, although patients usually find this procedure exhausting. During this surgery, the patient will be asked to move, talk and report symptoms, to help the surgeon place the leads in the precise location to best suppress the tremors and minimize side effects.
Surgery to implant neurostimulator(s) and extensions
About two weeks after the stereotactic surgery, a separate surgery is performed to implant one or two pace-maker-like devices, called neurostimulators, under the collarbone. Wires are also placed under the skin that run behind the ears and down the neck, to connect the neurostimulator(s) with the leads.
Initial programming of the implanted neurostimulator
The system is left off until this session, which takes place about a month after the second surgery. A team neurologist uses a programming device that sends wireless signals to turn on and adjust the system. Initial programming may take several sessions, to get the optimum symptom control for the patient.
Deep brain stimulation patients will have a lifelong relationship with the neurologist, who will periodically perform noninvasive “tuning” to ensure the best control of symptoms as a patient's condition changes over time.
Periodic battery replacement
Minor surgery is required to replace the neurostimulator batteries every three to six years, depending on use.
Safe and Effective
Approved by the FDA in 1997, deep brain stimulation inactivates, but does not destroy, the parts of the brain responsible for the shaking. This is an improvement over alternative treatments, called thalamotomy and pallidotomy, that surgically destroy tiny parts of the brain, and has been shown to be equally effective.
MidMichigan uses the Medtronic Activa® system for deep brain stimulation. This therapy has helped more than 15,000 patients around the world control shaking and other symptoms caused by Parkinson’s disease and Essential Tremor. More than 100,000 patients with Parkinson’s disease have also used deep brain stimulation to minimize diskinesia or "freezing" that is often a side-effect of medications such as levodopa.
Medtronic has performed clinical studies showing that:
- Deep brain stimulation suceeded in suppressing or completely eliminating tremors in the majority of Essential Tremor patients1
- Parkinson's disease patients gained an average of 6 more hours of "on time" per day2
- Essential Tremor and Parkinson's Disease patients experienced the ability to return to many activities of daily living that were formerly difficult or impossible, such as pouring liquids or dressing themselves3
Patients typically go home the next day after the lead implantation surgery and the same day of the neurostimulator implantation surgery.
Costs and Insurance
Deep brain stimulation costs about $30,000 plus physician and MRI fees. This surgery, when recommended by a doctor, is typically covered by insurance, but patients should check with their insurance carrier to verify coverage and co-pays.