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Alternatives to DBS
DBS isn ’ t for everyone . Some people have a mix of symptoms that won ’ t respond to DBS . Others don ’ t want surgery . Still others wish to avoid regular programming and long-term maintenance .
DBS is an optional , or elective , procedure . Even when doctors strongly recommend DBS , it ’ s not mandatory . There are a few non-DBS treatment options for progressing Parkinson ’ s , and more on the way . Alternatives may include :
+ Medication infusion A gel formulation of levodopa / carbidopa ( Duopa ) can be continuously infused , directly into the small intestine , through a surgically implanted tube . This bypasses the stomach , which often empties irregularly in Parkinson ’ s . Continuous delivery makes for more consistent medication levels in the blood and brain . As with DBS , this may reduce “ off ” time and dyskinesia . Unlike DBS , it does not require regular programming , but may require care partner support to maintain the pump and tube and to help administer medication .
Researchers are investigating longterm benefits , risks and side effects of focused ultrasound . They ’ re also evaluating whether this treatment can be used safely on both sides of the brain or in other brain areas , such as the subthalamic nucleus ( STN ), which is used for DBS but not yet for focused ultrasound . Separately , scientists are exploring focused ultrasound to temporarily relax the blood brain barrier , which protects the brain , to improve delivery of newer medications into the brain , where they need to work .
Before Surgery
Treatment options will expand as new therapies move through clinical trials and approval processes . These include continuous , under-the-skin infusions of levodopa / carbidopa or apomorphine , a drug that mimics dopamine , the brain chemical that decreases in Parkinson ’ s .
+ Other surgical options Focused ultrasound is a surgical procedure that destroys tiny , well-defined areas of brain cells to ease symptoms . Essentially , this treatment burns a small hole in a targeted area of the brain . Like DBS , it works in specific brain areas that cause tremor or dyskinesia . Unlike DBS , it does not require incisions , wires , batteries or programming . It ’ s a one-time procedure that takes effect immediately . But it ’ s not yet clear how long benefits may last . Focused ultrasound is also irreversible , so any side effects could be long-lasting or permanent . The treatment is currently FDA-approved for only one side of the brain in people with Parkinson ’ s tremor or dyskinesia , which means it only treats limited symptoms on one side of the body . Some people may not be eligible for focused ultrasound because of their symptoms , skull thickness or density , or other factors .