For medically refractory patients with Parkinson’s disease, essential tremor or dystonia, deep brain stimulation (DBS) offers a safe, effective way to improve their symptoms and reduce—sometimes completely eliminating—the need for certain medications. Notably, Cooper is the only medical center in South Jersey to offer DBS.
DBS is a neurosurgical procedure in which a neurostimulator delivers small electric shocks via implanted electrodes to specific parts of the brain. The electrical impulses render these parts of the brain inactive without surgically destroying them, thereby reducing tremor and blocking involuntary movements in patients with certain movement disorders and other conditions.
“In patients with Parkinson’s who undergo DBS, we’re seeing total or near-complete resolution of tremor, and improvement in rigidity and dyskinesia,” says James C. Barrese, MD, a neurosurgeon with the Cooper Neurological Institute who specializes in DBS. “For those with essential tremor, we’re seeing complete resolution or, at the very least, a drastic reduction in symptoms.
“While I tell most patients they can expect to reduce their movement-disorder medications by at least 75 percent, lately we’ve been getting patients completely off them,” he continues. “Reducing medication dependence is one of the biggest reasons patients seek DBS, so this is a significant upside of this procedure,” he adds.
“What’s more, unlike medications— for which pat ient s can develop a tolerance—DBS continues to work for a lifetime,” Dr. Barrese notes. “We may have to titrate up the voltage over time, but symptom relief is maintained.”
While Dr. Barrese performs the procedure to implant the electrodes and neurostimulator, Cooper neurologist Andrew McGarry, MD, performs the programming to determine the optimal stimulation parameters after implantation and over time.
Who is a candidate for DBS?
“Patients with Parkinson’s disease who are having severe motor fluctuations and dyskinesia, and have become tolerant to medication, are ideal candidates,” Dr. Barrese explains.
Anyone with advanced dementia or Alzheimer’s disease probably would not do well with DBS, he notes. “And if someone with Parkinson’s disease is not responsive to dopamine, that patient is unlikely to respond to DBS,” he says.
Are there other indications for DBS?
“Essential tremor is the second-most common condition for which I perform DBS, and dystonia is the third,” he continues. “In addition, the FDA recently approved DBS for treating obsessive-compulsive disorder (OCD), and it’s showing promising results,” he adds. DBS is also used in multiple sclerosis patients to help control arm tremor.
The applications for DBS are likely to continue to expand, with research underway to investigate its efficacy in treating major depression, stroke recovery, addiction, and dementia.
DBS has been performed since the 1980s; an estimated 40,000 people have successfully undergone treatment, and the technology continues to evolve.
“The biggest change is that we have replaced the stereotactic head frame with an image-guided frameless approach,” Dr. Barrese explains, referring to how a patient’s head is immobilized during the DBS procedure. “It vastly improves the patient experience because it’s more comfortable and less constricting.”
Despite decades of successful outcomes with DBS, some community physicians still hesitate to refer patients with movement disorders for this procedure—depriving them of the opportunity to improve their symptoms and reduce or eliminate medications.
“This treatment has been proven to be very safe, and it works extremely well,” Dr. Barrese says. “If you have questions about whether a certain patient is a candidate for DBS, please send them for an evaluation,” he urges. “We’re not here to take your patient, but to help them with this specific problem.”
For more information about DBS surgery for Parkinson’s disease, or to refer a patient, please call Dr. James Barrese at 941.685.7724.