6Deep Brain Stimulation and Parkinson’ s
DBS does not seem to directly affect non-motor symptoms, such as sleep problems or pain. But, because it improves motor symptoms, DBS might improve some non-motor symptoms as well. If DBS relieves nighttime tremor or difficulty turning over in bed, for example, you might naturally sleep more soundly and have less pain.
Who May Be Eligible for DBS
DBS doesn’ t work for everyone. And because it involves brain surgery and living with a device in your body, doctors are careful to recommend DBS only when it’ s most likely to offer benefit and least likely to cause side effects or complications.
Deep brain stimulation typically works best in people who:
Have had a Parkinson’ s diagnosis for at least four years experts consider DBS to be“ too early” if motor symptoms, such as tremor, slowness and stiffness, are adequately controlled and medications don’ t cause unacceptable side effects.“ Too late,” on the other hand, could be if, as disease progresses, balance problems or significant cognitive changes develop. These symptoms do not respond to DBS and could potentially offset any benefits.
DBS also does not work for people who have atypical parkinsonism, or“ Parkinson’ s plus” syndromes, such as Multiple System Atrophy( MSA), Progressive Supranuclear Palsy( PSP) and others. These diseases can mimic PD early on but“ declare” themselves within a few years by not responding to levodopa; progressing more quickly; or bringing earlier, more severe symptoms. Atypical parkinsonism can be hard to separate from Parkinson’ s, especially in the early years. But newer tests that detect abnormal alphasynuclein protein, the hallmark of PD, in the spinal fluid or skin may, in some cases, help your doctor make a more accurate diagnosis.
Benefit from levodopa, but have complications
Do not have significant memory or mood changes
Are generally in good health
Have Parkinson’ s for at least four years DBS is FDA-approved for people who have had a PD diagnosis for at least four years. Beyond this, there are no hard and fast rules because everyone’ s symptoms and course are different. But there are indicators that may point to the right“ window” for DBS. A person may be a good candidate, for example, when they have a good response to levodopa and are still physically active, but they have trouble with how long medications work or with dyskinesia. Many
Researchers wonder whether DBS may be beneficial earlier in PD, before complications arise. Small studies suggest that DBS may lessen symptoms and medication needs in people who’ ve had Parkinson’ s for less than four years. Larger, longer, controlled trials will help fully evaluate potential benefits and safety of earlier DBS.