DBS refers to deep brain electrical stimulation. Electrodes are implanted at specific locations in the brain through a precise positioning method and then connected through a subcutaneous tunnel to an electrical stimulation generator placed under the skin in the chest. The physician can adjust the parameters of the electrical stimulation to modulate the conduction signals in the brain with microcurrents to correct the abnormal motor symptoms and control the patient’s symptoms. This treatment is reversible and the electrodes and stimulation generator can be removed if the results are not satisfactory.
Which patients are suitable for DBS surgery?
1. The patient must be diagnosed with Parkinson’s disease and not other atypical Parkinson’s disease, or secondary Parkinson’s disease.
2. The patient should have normal intelligence and memory, usually patients with dementia are not suitable.
3. Assessment of drug effectiveness. Whether there is significant symptomatic improvement in the past with levodopa, whether the patient’s current drug response period is significant, and whether the patient has good mobility during the drug response period.
4. There must be no other serious chronic diseases, such as severe diabetes, poorly controlled hypertension or depression, etc.
5. Patients and their families must have a proper understanding of DBS, including the surgical procedure and post-operative follow-up treatment. In particular, they should have a full understanding of the surgical results and should not expect too much. Surgery can only improve the motor symptoms, reduce the time of “off” phase and reduce the time of “on” phase with dyskinesia, but cannot make the situation of “on” phase better. In addition, DBS cannot reverse Parkinson’s disease, and Parkinson’s disease will continue to worsen.
The effect of DBS usually decreases with age, while the risk of surgery increases with age. Therefore, the procedure is rarely performed on patients over 75 years of age unless they are in good physical condition and meet all other conditions.
7. The patient’s brain MRI must be basically normal and free of other serious diseases such as brain tumor, cerebrovascular disease and hydrocephalus.
What benefits can be achieved with DBS?
Since there are so many requirements for the inclusion of the procedure and it is expensive, what are the expected results of DBS? In short, DBS treatment can significantly improve the quality of life of Parkinson’s patients and caregivers by providing comprehensive control of motor symptoms, reducing dyskinesia, and increasing the “on” period. Details are as follows.
1, reduce the main motor symptoms of Parkinson’s disease patients, such as limb tremor, muscle stiffness, reduced movement. 1 year after the motor score improvement in about 60-70%, and long-term effective, 5 years later still reached 54%. Among them, the improvement of tremor was the most obvious, and the improvement degree was 75%, 83% and 75% at 1 year, 3 years and 5 years respectively.
2.Reducing the difficulty of movement caused by levodopa, and the duration and severity of the akinesia can be significantly improved.
3.Increase the duration of the “open” period of the patient without akinesia. A 6-month post-operative study showed that the percentage of duration of “open” period without dyskinesia increased from 27% to 74% per day.
4. The dose of anti-Parkinsonian drugs can be reduced, usually by 1/3 to 1/2 of the dose.
5. Patients’ own perceptions show that DBS treatment improves their ability to perform activities of daily living, including movement (48%), general status (34%), mood (29%), social support (63%), independence and participation in social activities, renewed interests, and improved sleep quality.
What are the disadvantages of DBS?
1. The price is too high, currently over $250,000 for bilateral surgical materials, which is not covered by health insurance.
2. General anesthesia is required.
3. The battery has a certain service life, usually requiring surgical replacement after 4-6 years, even if it is a rechargeable battery, its life does not exceed 9 years.
4. The internal implant may cause local infection or even systemic infection due to skin breakdown.
Although DBS surgery is not a perfect solution and has some drawbacks, even at the beginning of its promotion, I was also apprehensive because of certain reasons. However, DBS has proven to be an undeniable improvement in the quality of life for Parkinson’s patients, giving them a chance to live with dignity again. I think the truth is that many diseases do not break the patient’s body, but his or her will and spirit. Restoring dignity is what DBS can give us.
Facing the disease, demotivation can only fuel the disease, open the window inside, we still have tomorrow!