DEEP BRAIN STIMULATION

This surgical technique involves implanting an electronic pulse generator similar to a pacemaker underneath the skin near the collarbone.  A fine wire under the skin connects the generator to electrodes implanted deep in the brain.  Stimulating the parts of the brain affected by Parkinson's disease can help improve motor function.

The implanted device helps to treat the 'motor' symptoms of Parkinson’s disease including stiffness, slowness and tremor and helps reduce fluctuations in these symptoms that occur in people who have had the condition for several years. It's not a cure, but it may help to control many symptoms. It may also mean less medication, which can reduce the risk of medication side effects, such as involuntary movements (dyskinesia).

The long-term safety of deep brain stimulation is established with over 200,000 patients with Parkinson's disease implanted worldwide.  The treatment is also extremely effective for many movement disorders including dystonias and blehparospasm and tremors of unknown cause, after head injury, other diseases like multiple sclerosis and stroke.  Stereotactic lesional surgery can also be offered as an alternative to deep brain stimulation.

Treating Parkinson's disease with drugs

Once symptoms of Parkinsons disease become noticeable, early treatments centre on drug therapy to boost levels of dopamine in the brain. This neurotransmitter is lost when key nerve cells in the substantia nigra, the part of the brain where the movement control centres are located, die in large numbers.

Research is on-going to determine which drug treatment is most effective and produces the fewest side effects during the early and late stages of Parkinson's disease. Currently, three main drugs are used to enhance dopamine levels:

  • Levodopa is a chemical building-block that the body converts into dopamine to top up the reduced levels in the brain.
  • Dopamine agonists stimulate the nerve cells by acting as a substitute for dopamine.
  • Monoamine oxidase-B inhibitors block the effects of the brain enzyme that breaks down dopamine.

Other drug treatments are also sometimes used, but usually in conjunction with one of the main three therapies.

Supportive treatments for Parkinson's disease

A range of additional support therapies are available for Parkinson's disease, which may be helpful as the disease progresses. These alleviate stress and anxiety quite effectively, improve overall well-being, and generally help people with Parkinson's disease to cope with day-to-day life:

  • Physiotherapy: physical treatments, including exercise, to reduce joint stiffness and help with posture and movement.
  • Speech and language therapy: techniques to help with communication, both in terms of speech and facial expressions, difficulties swallowing or problems with saliva.
  • Occupational therapy: practical help and suggestions, such as mobility equipment and disability aids to modify the home or workplace.
  • Help from a dietitian: nutritional advice to help deal with weight gain, weight loss, constipation or other dietary problems.
  • Help from a psychologist  for coping with depression, anxiety or any other mental health problems.
  • Complementary therapies: many people with Parkinson's disease find they derive a lot of benefit from non-medical therapies such as aromatherapy and massage that can be used alongside orthodox treatments.

This surgical technique involves implanting an electronic pulse generator similar to a pacemaker underneath the skin near the collarbone. This can be programmed remotely with a handheld controller. A fine wire under the skin connects the generator to electrodes implanted deep in the brain; stimulating the parts of the brain affected by Parkinson's disease can help improve motor function.

The implanted device allows people with Parkinson's to control the level of stimulation and they simply use the remote when they want to move but find it difficult. The extra brain stimulation can help them ‘get going’.

The long-term safety of deep brain stimulation is yet to be proven but the outcome so far is extremely encouraging. Studies have found it to be an effective therapy for advanced Parkinson's disease up to 5 years after implantation, although its benefit gradually reduces over time. As a result, deep brain stimulation is likely to continue as the main surgical treatment offered for Parkinsons disease for the foreseeable future.