Held in partnership with the University of Edinburgh and the Journal of Parkinson’s Disease, with Edinburgh University’s Professor Tilo Kunath as chair, this edition of our quarterly webinar series focused on DBS.
Deep Brain Stimulation (DBS) is a surgical treatment for Parkinson’s that involves implanting electrodes in the brain. These electrodes produce electrical impulses that stimulate brain activity, which can help relieve Parkinson’s motor symptoms.
This hour-long webinar was focused on DBS and a special emphasis on an emerging form of this therapy: adaptive DBS. Edinburgh University’s Professor Tilo Kunath was joined by an expert panel to discuss what DBS is, how the therapy works and interacts with the brain, and whether DBS, especially adaptive DBS, could have a disease-modifying effect.
The recording for this webinar is now available.
Pre-Reading Document
FAQ
What is DBS?
Deep Brain Stimulation (or DBS) is a neurosurgical treatment where electrodes are placed in the brain and attached to a pulse generator (a device similar to a pacemaker) implanted in the chest or abdomen. It does not involve the administration of any active drugs; instead, it relies on electrical impulses to regulate nerve cell (neuron) activity.
What Parkinson’s symptoms does DBS help with?
DBS is most effective for treating the motor symptoms of Parkinson’s, including tremor, slowness of movement (bradykinesia), rigidity, and gait problems. The effects of DBS on nonmotor symptoms of Parkinson’s, such as sleep, mood, and cognition, are still being studied, but it is not primarily used for these symptoms.
Tremor refers to involuntary shaking or trembling in one or more parts of the body. Most often this affects the hands.
Bradykinesia refers to the gradual slowing of movement, including difficulties initiating movement and reduction of automatic movements (e.g., blinking, swinging arms when walking).
Rigidity refers to the feelings of stiffness or tightness in the arms or legs, reducing movement.
Gait refers to the way in which someone walks. In Parkinson’s, people often experience a change in their gait, such as a slow, shuffling walk.
When should someone consider getting DBS? Are there restrictions?
DBS is offered to patients experiencing motor symptoms that are no longer effectively controlled by medication, and these symptoms are severe enough to affect daily life. Those motor symptoms that responded well to medication before surgery are usually the ones that improve most with DBS.
If you experience memory and cognition issues, DBS can sometimes make these symptoms worse. It is important to discuss these with your neurologist when considering DBS.
Although there are no set age restrictions for DBS, the treatment is often more effective and safer for individuals who are younger and earlier in the condition. DBS is not typically offered to people over the age of 80.
An additional consideration is that having DBS will exclude individuals from most clinical trials for Parkinson’s. If you are interested in taking part in research in this way, this may not be a suitable treatment option.
If you are interested in receiving DBS, we recommend speaking to your neurologist.
What are the risks associated with the procedure?
As with any neurosurgical procedure, there are risks associated with DBS. These include potential for bleeding or stroke during the procedure, as well as complications associated with anaesthesia. Although these incidents are rare, they are something to discuss with your neurologist ahead of the procedure.
To help ensure safety, before being considered for surgery, you will also undergo a series of evaluations and tests with your neurologist to determine if DBS is right for you.
What happens after the DBS system is implanted?
After the DBS device is implanted, it requires ongoing management. The battery may need to be recharged or replaced periodically, and the device is programmed to match the individual. Settings are adjusted by the specialist to find the most effective configuration, and these may be updated over time as symptoms change. Regular follow-up visits may be needed to ensure the device continues to provide the best benefit and to monitor for any issues.
How does DBS differ from Produodopa pumps?
Produodopa does not require surgery; instead, a small needle is injected under the skin and connected to a pump worn externally. This allows for the continuous release of a formulation of levodopa-carbidopa (foslevodopa-foscarbidopa) to reduce fluctuations in motor symptoms (off periods) often experienced between doses of levodopa tablets.
Both treatments are intended to help regulate and decrease severity of motor symptoms and can help reduce the amount of medication a person needs to take. Each has specific benefits and disadvantages that should be discussed with a neurologist.
If someone already has DBS, can their device be modified to become adaptive DBS?
Adaptive DBS is a new form of DBS that involves recording brain activity and a small computer instructing the pulse generator to stimulate accordingly. So rather than a continuous pattern of stimulation (which is how conventional DBS works), the stream of stimulation in adaptive DBS is constantly changing according to the needs of the brain. Some brands of the DBS device may eventually offer a switch to adaptive. It is important to note that standard DBS remains a highly effective treatment, and the ability to become adaptive DBS should not be a major factor when deciding whether to receive this treatment.
Can DBS slow Parkinson’s progression?
Our understanding of DBS currently is that it is only able to provide symptomatic relief and does not affect progression.
As discussed in the webinar, Dr McFleder’s team in Würzburg are investigating whether DBS could be interacting and decreasing neuroinflammation – a known driver of neuron loss in Parkinson’s. Dr McFleder’s results require replication, but they provide exciting new avenues of investigation for the field. Read their latest paper here.
Where can I learn more?
Parkinson’s UK has a free, comprehensive guide to DBS available on their website: https://www.parkinsons.org.uk/information-and-support/deep-brain-stimulation
Two of our panelists, Dr Alfonso Fasano and Benjamin Stecher, have co-written a book on
their experience with adaptive DBS from the perspective of the doctor and patient. Learn more about this here.
Meet our panellists
Dr Alfonso Fasano is the Chair in Neuromodulation at the University of Toronto and University Health Network. He is a Professor in the Department of Medicine (Division of Neurology) at the University of Toronto and at Humanitas University in Milan, Italy. His research focus is on the use of advanced technology, such as DBS, to treat movement disorders, including Parkinson’s, as well as the pathophysiology of the condition.
Dr Rhonda McFleder is a Tenure Track Professor in Translational Medicine at Universitätsklinikum Würzburg, Germany. Dr McFleder’s research focuses on mechanisms underlying Parkinson’s and how inflammation may play a role in progression of the condition. Her recent work has focused on how DBS interacts with the immune system, and how this may have a disease-modifying effect.
Ben Stecher is a Parkinson’s Advocate, Associate Director at The Silverstein Foundation for Parkinson’s with GBA, and Chair of the Patient Advisory Board at Rune Labs. He is also a scientific writer, co-authoring two books on Parkinson’s. Ben was one of the first patients to receive adaptive DBS from the ADAPT-PD trial in 2021.
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