Hello Den, Arthur, Jane, Nancy, Janet and all,
In recent postings were questions about DBS.
Here is a summary from the Patient Consent Form as used in Grenoble, France,
during the research study of DBS for treatment of advanced PD.
In general this operation may ONLY be appropriate for you if:
-It's CERTAIN you have PD (you have to react to L-dopa).(NOT Parkinsonism!!)
-You have NO cognitive or memory problems/deficits.
-NO (light) dementia or (severe types of) depression.
-NO circulatory problems.
-NO other "brain"-problems.
BTW: I have had NO DBS.
Do you think it's a possible solution for you, don't ask ME if it is!!
Ask your neuro or get info from the institutions, where these treatments
(are going to) take place!!
Greetings, Hans.
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CHRONIC ELECTRICAL STIMULATION OF THE SUB-THALAMIC NUCLEUS OR THE GLOBUS
PALLIDUS FOR THE TREATMENT OF ADVANCED PARKINSON'S DISEASE
Recent clinical studies have shown that DBS (Deep Brain Stimulation) is
effective to treat tremor with PD.
Recently stimulating areas of the globus pallidus or the subthalamic nucleus
has been proposed as a therapy for treating several other disabling symptoms
associated with PD and L-dopa induced side-effects.
The implanted DBS system consists of:
- a lead, which consists of insulated wires with four electrodes at the end
- an extension wire which connects the lead to the power source
- an Implanted Pulse Generator (IPG), which is the power source
The IPG is a metal "can" about 5 cm (= 2 inches) in diameter and about 1.3
cm (= 1/2 inch) thick. It contains a small battery and produces the
electrical pulses needed for stimulation. After 3-5 years the IPG with the
battery has to be replaced (by minor surgery).
The implantation takes place in two stages:
1) the lead is placed in the brain by stereotactic neurosurgery, through a
small opening in the skull, using LOCAL anesthetic.
(So during the operation you are conscious!!)
Your hair must be shaved to avoid infections.
During the procedure/operation the doctor asks questions about your
PD-symptoms to make sure the lead is in the right place. Once determined,
the lead may be connected to wires which run through the skin to a temporary
external stimulator. The doctor will test the DBS system to see if your
PD-symptoms are treated adequately (for 2-7 days).
If you receive good symptom relief, the 2nd stage takes place.
2) the temporary wires are removed and a permanent extension wire is passed
under the skin of the neck and attached to the IPG, which is also placed
under the skin, just below the collarbone.
During operation the doctor may elect to do stage 1 and 2 at the same time.
BENEFITS
- substantial control over the symptoms, but NOT over the underlaying PD.
- improve quality of life
- decrease L-dopa-induced side-effects
Only the doctor can adjust the stimulation to optimize the result.
You receive a (strong) magnet so you can turn the stimulation off and on.
RISKS
(Brain)surgery is never without risks.
Besides the general surgery and anesthesia risks, the implantation may cause
the following complications:
- bleeding (hemorrhage) inside the brain, which could lead to stroke.
this risk increases with age: high BP or over 60: 5%; under 40: 1%.
- movement disturbances, vision problems, loss of sensation, mental
impairment.
- (severe) brain-infections
- seizures
- leaking of the fluid which surrounds the brain
- post-op sleepiness, confusion, and/or hallucinations.
- cerebral infarct
Risks AFTER implantation:
- failure of the DBS system
- pain or fluid accumulations at the IPG site
- IPG may change position or erode through the skin
- allergic reaction
- migration or movement of the lead in the brain
Risks with stimulation:
- effectiveness changing over time
- paraesthesias of limbs or face
- speech problems
- dizziness
- movement problems
- hypaesthesia
- attention and cognitive deficits
- temporary worsening of symptoms when stimulation is stopped
- visual problems
The lead will remain implanted indefinitely.
TO MINIMIZE RISKS
A full physical and neurological examination takes place to determine if DBS
is appropriate for you.
ALTERNATIVES
The main alternative is a destructive lesion of the globus pallidus or the
subthalamic nucleus.
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