FAQ for Patients: Deep Brain Stimulation for Parkinson's Disease

Neurosurgeons: Philip A. Starr MD, PhD; Paul S. Larson MD
Neurologists: Jill Ostrem MD; Alec Glass MD; William J. Marks, Jr. MD
Nurses: Monica Volz RN; Robin Taylor RN; Susan Heath RN
Research Coordinator: Jamie Grace

 

When should one consider surgical therapy?
What are the different types of surgery for Parkinson's disease?
What are the possible brain targets for DBS?
How does DBS work?
How is the surgery performed?
What are the cosmetic considerations with DBS surgery?
Why must patients be awake for part of DBS surgery?
Would both sides of the brain be done at once, or only one side?
What are the benefits of DBS surgery?
What are the risks of DBS surgery?
What makes a patient a good candidate for DBS for Parkinson's disease?
Where is the surgery performed?
What are the results and complications of DBS at UCSF?
What clinical trials are available at UCSF and what are the advantages of participating in them?
What determines the choice of STN versus GPi as the target?
What tests are needed prior to surgery?
How should the patient prepare for surgery?
What type of follow-up is needed after surgery? Who will program the DBS unit?
How long does it take before the full benefit of DBS is apparent?
Can patients control the DBS device themselves?
Are there any restrictions on a person's activity after a DBS system is implanted?
Can I have an MRI scan after DBS surgery?
Is DBS surgery covered by health insurance?
Summary
 
When should one consider surgical therapy?
 
For patients with early Parkinson's disease, levodopa (sinemet) and other antiparkinsonian medications are usually effective for maintaining a good quality of life. As the disorder progresses, however, medications can produce disabling side effects. Many patients on long-term levodopa develop troublesome dyskinesias, excessive movements that often cause the limbs and body to writhe or jump. In addition, their dose of levodopa no longer lasts as long as it once did. This may lead to "on-off fluctuations," a condition in which the ability to move changes unpredictably between a mobile ("on"), state when medication seem to work, and an immobile ("off") state in which little effect of medication is apparent and normal movement is very difficult. When patients no longer have an acceptable quality of life due to these shortcomings of medical therapy, surgical treatment should be considered.
 
What are the different types of surgery for Parkinson's disease?
 
There are several different types of surgery for Parkinson's disease. The first surgical procedures developed were the ablative, or brain lesioning, procedures. Examples of lesioning surgery include thalamotomy and pallidotomy. Lesioning surgery involves the precisely controlled destruction, using a heat probe, of a small region of brain tissue that is abnormally active. It produces a permanent effect on the brain. In general, it is not safe to perform lesioning on both sides of the brain.
 
We continue to perform some lesioning surgeries for patients who desire it, although in our practice lesioning has been largely replaced by deep brain stimulation (DBS). DBS surgery involves placing a thin metal electrode (about the diameter of a piece of spaghetti) into one of several possible brain targets and attaching it to a computerized pulse generator, which is implanted under the skin in the chest (much like a heart pacemaker). All parts of the stimulator system are internal; there a