Changes help reduce patient fears and make procedure more accurate and accessible
Deep brain stimulation (DBS) for Parkinson’s has been shown to provide numerous benefits including greatly reducing medication use and extending quality and length of life. During DBS surgery, a device that is similar to a heart pacemaker is implanted. The device uses electrical pulses to regulate brain activity that causes symptoms from the movement disorder.
For patients with Parkinson’s disease, DBS can be a very positive, life-altering treatment. Yet, it’s estimated that only about 10% of patients with Parkinson’s undergo the procedure despite its many benefits. The low rate is due, at least in part, by misconceptions or outdated information. In this blog, I note four issues that have discouraged patients with Parkinson’s from having the procedure, and address them with advancements in DBS.
Whether you are newly diagnosed with Parkinson’s disease or have been living with the movement disorder for years, these four advancements in DBS may influence your decision to move forward with the procedure.
- DBS is now offered as an asleep procedure. Originally, DBS for Parkinson’s required the patient to be awake for the procedure. I have been performing DBS for Parkinson’s disease for years. Although my patients knew the extensive benefits the procedure offers for Parkinson’s symptoms, I saw too many patients forgo the procedure due to fears, particularly about being awake. I spent years helping develop robotic-guided Asleep DBS, a technique that allows patients to remain asleep during the procedure. The procedure is as safe as awake DBS.
- Accuracy of Robotic-Guided Asleep DBS eliminates repeat procedures, lowers infection rates. Asleep DBS greatly reduces the likelihood of DBS revision surgery. The national DBS revision rate is more than 15%, according to a study published in Parkinsonism and Related Disorders. Our DBS revision rate at the Denver DBS Center using Robotic-Guided Asleep DBS is closer to 1%. There are a few factors that impact this:
- My team at the Denver DBS Center found a 25% improvement in the accuracy of electrode placement with Asleep DBS as compared to traditional Awake DBS. Our study of 125 patients was published in the Annals of Biomedical Engineering. With robotic-guidance, electrode placement for DBS is within 1 millimeter of the target compared with 1-2 millimeters with traditional DBS. With this extreme accuracy, it virtually eliminates the need for repeat procedures.
- In addition, because surgery times with Asleep DBS are much shorter, infection rates are also much lower. In fact, our rate at Denver DBS Center less than 0.3%, compared to a typical infection rate of roughly 3-3.5%.
- DBS is now an option sooner in the disease process. Patients with Parkinson’s can now undergo DBS 4 years after symptoms begin rather than 7 years as originally required, according to the FDA’s latest guidelines. Research shows that undergoing DBS in the earlier stages of Parkinson’s disease is effective and greatly reduces medication use, and that DBS is more effective than medications in controlling tremors in patients with Parkinson’s disease. This update to the FDA approval now means people can benefit from higher quality of life for an extra 5-10 years. For many people, this means an extra 5-10 years of working or raising children – years that seem like a lifetime when facing this disease.
- Remote programming makes DBS more convenient. In 2022, our team at the Denver DBS Center was the first in the Rocky Mountain region to offer remote DBS programming. Traditionally, patients undergoing DBS had to physically go into their neurologist’s office to have their DBS system programmed and then adjusted. For the first 6 months following DBS surgery, these adjustments are done monthly to pinpoint the ideal settings. After that, follow-up visits happen as frequently as every three months. Because Parkinson’s disease is a progressive disease, meaning symptoms worsen and change with time, the DBS system must be reprogrammed fairly regularly. Now with the evolution of remote DBS programming, neurologists and neurosurgeons can adjust patients’ DBS systems through a secure internet connection, allowing the patient to stay at home during the programming. This advancement is truly game changing for patients who live in rural areas or have difficulty finding transportation and the time to commute to receive programming adjustments. Watch a video about a DBS patient and his experience with remote programming here.
With these advancements in DBS for Parkinson’s, I hope you or your loved one might consider the procedure if symptoms are not well controlled with medications.
David VanSickle, MD, PhD, FAANS, is a board-certified Denver-based neurosurgeon and medical director of the Denver DBS Center. He has performed more than 1,000 deep brain stimulation surgeries for patients in the U.S. and abroad. With a PhD in bioengineering, Dr. VanSickle is committed to advancing DBS and helped revolutionize the field with robotic-guided DBS surgery performed while the patient is asleep. Dr. VanSickle lectures widely, trains other neurosurgeons in Asleep DBS, and is an expert in the appropriate use of DBS to help patients with Parkinson’s, Essential Tremor, Dystonia and other movement disorders control their symptoms and gain years of active, fulfilling life. He can be reached at 720-638-7500 or toll-free at 855-202-9303.