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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.