7Before Surgery
Benefit from levodopa, but have complications Over time, many people continue to respond to levodopa, but experience complications or side effects that impact quality of life. For example, medication might work, but only for a short time, forcing you to take levodopa every two or three hours. Or, you could have extreme ups and downs, or“ motor fluctuations,” throughout the day, where time with few or no symptoms(“ on”) alternates with symptom return(“ off”), like a rollercoaster ride.
DBS generally works as well as your best“ on” time with levodopa. For this reason, some doctors call DBS“ electric levodopa.” The regular electrical stimulation of DBS can often provide a smoother, more even, predictable day.
One important exception to the requirement of levodopa benefit is tremor that does not get better with levodopa or other medications. DBS can help in this situation.
Do not have significant memory or mood changes DBS can worsen memory and thinking( cognitive) abilities. This is generally temporary but, in rare cases, may be permanent. People who have significant problems with memory and thinking are at greatest risk for worsening with surgery. Because of this, all potential DBS candidates undergo detailed memory and thinking tests( neurocognitive testing) as part of the screening process. If results are below normal, there is a higher risk of cognitive worsening and lower chance of a good outcome with DBS. Those with milder cognitive changes often are still eligible for surgery.
People with uncontrolled depression or anxiety may have trouble with the DBS process, procedure and programming, and they may be at risk for increased mood changes following surgery. Those with well-managed mood symptoms are typically able to have DBS.
Are generally in good health Doctors consider your overall health and suitability for surgery when evaluating for DBS. Certain heart diseases, blood pressure or clotting problems, or other medical conditions might make the procedure more risky.
There is no absolute age cutoff for DBS. Some medical centers find that people who are 70 or older may not experience as robust a response as younger people. But other factors such as Parkinson’ s symptoms, levodopa responsiveness, mood, cognition and other health conditions, are probably more important than age alone.