Deep Brain Stimulation
Deep Brain Stimulation (DBS) is a novel therapy involving the surgical implantation of electrodes into precise locations in the brain. In a follow-up surgery, the electrodes are connected to a cardiac pacemaker-like battery unit that is placed under the skin just below the collar bone. The electrical signals are produced by the battery unit and conducted to the brain through the electrodes, stimulating changes in communication between brain regions, and thereby reducing abnormal movements. DBS has been demonstrated to reduce the disabling symptoms of many movement disorders. Importantly, the effects of DBS are reversible. When the device is turned off, its effects disappear. DBS therapy has been shown to improve patient quality of life by ameliorating movement disorder symptoms. DBS has not been shown to alter the natural history of the disease itself.
Parkinson’s Disease: In the case of PD, carefully selected patients following DBS implantation have been shown to have improved quality of life compared to those treated without DBS surgery. The patients with PD who are most likely to benefit from DBS are those who are otherwise healthy, have a clear diagnosis of PD, experience significant improvement of symptoms with L-dopa preparations, have unimpaired cognition and have a normal brain MRI. Parkinsonian symptoms that most improve with DBS therapy are tremor, dyskinesias, and “on/off” fluctuations. Symptoms most likely to be worsened by DBS are cognition and voice volume.
Essential and Action Tremor: In essential tremor, thalamic DBS has been demonstrated to improve quality of life and to eliminate tremor in more than 50 percent of patients. Patients most likely to benefit from DBS are those with disabling tremor on their dominant side that has been inadequately responsive to pharmacological interventions. Other forms of action tremor also can be treated successfully with DBS. However, the effectiveness of DBS surgery in these disorders is more difficult to predict.
Dystonia: Dystonia is an abnormal, involuntary co-contraction of opposing muscle groups. Dystonia may be generalized throughout the body or limited to a region or muscle group. Torticollis and writer’s cramp are both examples of dystonia. Patients with a normal MRI who suffer from severe, disabling dystonia that is inadequately responsive to pharmacological therapy and to botulinum toxin, may significantly benefit from deep brain stimulation. At Michigan, we have approval though a Humanitarian Device Exemption from the FDA to treat patients suffering from dystonia with DBS.
Multiple Sclerosis: Patients with Multiple Sclerosis (MS) may develop positional or action tremor as a manifestation of their disease. Although the response rates are lower than other patients with other tremor disorders and normal MRI scans, patients with MS-associated tremor have been shown to respond to thalamic DBS and to thalamotomy.
Appointment Number: 734-764-6831
East Ann Arbor Health and Geriatrics Center
4260 Plymouth Road
Ann Arbor, MI 48109-5796
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