October 15, 2014

Deep Brain Stimulation: Remain Asleep and Don't Stop the Meds

New state-of-the-art imaging technology now allows Parkinson’s patients undergoing deep brain stimulation (DBS) to reman asleep during the procedure.

I don’t know about you, but if someone was planning to drill a hole in my skull and insert a wire through that hole and into my brain, I’d just as soon not be awake through any of it.

DBS results have been so compelling that the Food and Drug Administration approved the procedure for treatment of essential tremor (in 1997), Parkinson’s (2002), and dystonia (2003).

Over 100,000 people worldwide have undergone the procedure to alleviate motor symptoms -- tremor, rigidity of limbs, and movement problems -- that medications did not effectively address. Until now, these DBS patients would have to awakened to let their surgeons know when the electric probe had hit the key spot in the brain causing the problem.

For instance, doctors might ask their wakened patients with tremor draw spirals on a whiteboard. Before the correct area of the brain was hit with the probe, the spirals were erratic and jagged. When the probe hit just the right spot – no bigger than a pea – the patient’s spirals would become much more even, steady, rounded. That’s where the surgeon would plant the wire.

From Eight to Four Hours
New MRI imagery gives surgeons very precise, real-time pictures of their patients’ brains at work… while those patients sleep comfortably. The new procedure also shortens the surgery time -- from about eight to four hours. When the right spot is located, a battery pack is then implanted under the skin near the collarbone to keep the signals coming.

Dr. Hooman Azmi -- director of the division of movement disorders at Hackensack University Medical Center in New Jersey -- said, “Surgery is safer because it’s shorter; the patient is more comfortable, and we can see the wires going in. If there’s any bleeding we could see it."

No Need to Go Off Meds Now
In addition to staying awake, DBS patients in the past also had to go off their PD meds before the procedure – a disruption of the carefully orchestrated dosage and timing of medications… and the length of the interval between pills. That tricky scheduling often takes patients and their doctors years to get just right, and usually changes as people’s Parkinson's progresses.

Now, with the new MRI imaging, DBS patients with PD do not have to discontinue their medication before the procedure... a big plus.

Fear Factor
Here's another important consideration: -- in the past, many patients with advanced PD who might benefit from DBS chose not to go ahead with the procedure, because they were understandably afraid of being awakened in the middle of it.

All things considered... a positive step forward in the treatment of Parkinson's.

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I’ve written about DBS before:

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