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Thursday, April 14, 2016

Minimally invasive deep brain stimulation may benefit people with Parkinson’s disease or essential tremor

Dr. George Mandybur
Dr. George Mandybur is a neurosurgeon with Mayfield Brain & Spine and a movement disorders specialist at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders

For more than 15 years deep brain stimulation (DBS) surgery has been an important treatment option for people with Parkinson’s disease, a disorder of the nervous system caused by a steady loss of dopamine in the brain. Although DBS does not cure Parkinson’s disease, it has helped a multitude of patients maintain quality of life through reduced symptoms. Studies performed in the United States and Europe have shown that DBS surgery is superior to best medical management.

Best known as a treatment for Parkinson’s, DBS is also an important treatment for essential tremor, which afflicts about 10 million Americans -- eight times as many people as Parkinson’s. Essential tremor, a progressive neurological condition that causes a rhythmic trembling of the head, voice, legs or trunk, has no definitive cure.

Both Parkinson’s and essential tremor are frequently treated at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati Neuroscience Institute. 

For people with Parkinson’s or essential tremor who have medically intractable tremors, DBS surgery is their only option, outside of suffering. While only select patients with Parkinson’s qualify for surgery, many patients with debilitating essential tremor will qualify for this procedure.

Once offered to Parkinson’s patients as a last resort, new research suggests that the procedure should be offered earlier in the disease process, when more of the affected brain cells are still alive. By intervening sooner, we have more nerve cells to help out. If we wait too long, the effect tends to be less. The FDA’s approval of DBS for Parkinson’s disease does not specify a time course. But we have performed surgery on patients within five years of diagnosis because of symptom severity, with positive effects.

DBS surgery involves implanting tiny electrodes deep inside the brain and connecting them to a programmable, battery-powered device that creates painless electric pulses. The device, which resembles a heart pacemaker, is implanted beneath the collar bone. Medical science is not sure exactly why DBS works, but doctors theorize that the stimulation modulates or overrides circuitry deep within the brain, where the disease is occurring. The surgery is “minimally invasive” because it involves two small, quarter-sized incisions in the skull. A somewhat larger incision is made under the collarbone for placement of the stimulator device and battery pack. After DBS surgery, our Gardner Center team fine-tunes the pacemaker-like stimulator device, adjusting it bit by bit at regular office visits.

The future of DBS surgery is bright. On the horizon are “smart stimulators” that sense the brain’s imperfect signals and suppress them. Preliminary data shows that we might be able to improve patients’ function 20 percent. Patients who have already undergone the procedure could simply get a replacement battery.

George Mandybur, MD, is a neurosurgeon with Mayfield Brain & Spine and a movement disorders specialist at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders. For more information, please visit http://ucgardnercenter.com/ or call (513) 475-8730.

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