“What I would tell someone else about this disease is to be patient. We take it one day at a time, and deal with whatever develops as it develops. We have our good days and we have days that are not so good. Sharing fears and concerns and working together to find answers or solutions to these problems is good therapy for both of us.”
—ANONYMOUS, PWP
There are a few surgical procedures that can help improve the quality of life in someone with Parkinson’s. Not all surgeries are for everyone, and it’s best to read up on them and discuss them with your doctor to find out whether you would be a good candidate for any of them. Also, you should know that although surgery can be an effective treatment option for certain symptoms of PD, it is not a cure and it does not slow the progression of the disease.
The most popular surgery used to treat PD is deep brain stimulation (DBS). Although it is considered a newer surgery, DBS has been around for decades and is proving quite successful in reducing certain symptoms of the disease.44 DBS usually works best at reducing motor symptoms such as tremor, slowness, and stiffness.
Below is a detailed summary of DBS, along with two other types of surgery that are sometimes used to help treat Parkinson’s.
DBS inactivates the parts of the brain that cause Parkinson’s without purposefully destroying them, as is done in the other two surgeries summarized below.
During this procedure, electrodes are inserted into a targeted part of the brain that controls movement and then connected to a small battery-operated device (a neurostimulator similar to a pacemaker) that is typically implanted just below the collarbone on the chest. Once activated, this device, called an implanted pulse generator (IPG), is programmed to send electrical pulses to four electrodes implanted in the brain.
Patients are given a controller so that they can turn the device on and off, check the battery status, and self-adjust within certain parameters. The IPG battery lasts for about three to five years and is relatively easy to replace under local anesthesia.
DBS has been successful in treating people of different ages; however, the surgery is approved only for those who have had PD for at least four years. In addition, each person must be assessed individually to determine fitness for surgery. DBS is most effective for people who suffer from major tremors and medication-induced dyskinesias. If your medication works but you find you’re having too much dyskinesia and off time, you may want to consider DBS.
If you have trouble with balance or freezing, DBS won’t help you as much. Also, DBS doesn’t work well for nonmotor symptoms and is not recommended for those with dementia (it may make it worse).
Researchers are working on ways to make DBS effective at treating more symptoms of Parkinson’s and are looking to test the procedure within a year after diagnosis to see if it could slow or stop the progression.
Talk to your doctor to see if DBS is right for you. If you are thinking of having this surgery, it is very important that you be well informed about the procedure and realistic about your expectations.
Below are some of the advantages and possible disadvantages of having DBS surgery.
Advantages
• DBS is able to treat several of the major symptoms of PD, allowing it to both improve quality of life and ease the strain of performing daily living tasks.
• The stimulation device can be adjusted without further surgical procedures. This means that as the disease progresses or medications change, the treatment can adapt as needed.
• The procedure itself is relatively safe, causes little discomfort, and does not involve the purposeful destruction of any part of the brain.
• Many patients are able to reduce their medication dosage or frequency.
Possible disadvantages
• Implanting any foreign object in the body subjects the person to an increased risk of infection. Infections are typically minor and can be treated, but they can be life-threatening. In some cases, the entire device must be removed to allow the infection to heal. This necessitates a second surgery at a later date.
• If the equipment stops working altogether, the device will have to be replaced in another surgical procedure. The battery must also be replaced surgically every few years.
• It can take time (many months) after surgery to get the right balance of DBS and medications to control symptoms.
• Not all PD symptoms can be alleviated through DBS.
• All surgeries carry risk. While the risk level varies between patients, DBS surgery may result in bleeding, infection, or stroke. Talk to your doctor about your risk factors before making a decision.
Researchers have found that the part of the brain called the globus pallidus becomes overactive in people with Parkinson’s. This overactivity acts like a brake and slows or diminishes bodily movement. Pallidotomy surgery permanently destroys the overactive globus pallidus to lessen motor symptoms such as tremor and rigidity.
Doctors rarely perform pallidotomy anymore, but they may consider one if a person with advanced Parkinson’s has severe dyskinesia from long-term levodopa treatment.
Thalamotomy surgery destroys the part of the brain called the thalamus, which may help stop severe tremors. Because the left side of the brain controls the right side of the body and the right side of the brain the left side of the body, if you have a tremor on your right side, the surgery would be performed on the left side of your brain, and vice versa. Since thalamotomy is used only to control tremors, it is not generally recommended as a treatment for PD.
A relatively new treatment option for tremors is the magnetic resonance–guided high-intensity focused ultrasound. Referred to as MRgFUS or MRgHIFU (HIFU for short), this is a revolutionary, completely noninvasive treatment where magnetic resonance imaging (MRI) is used to guide and control the treatment, which is performed while you lie in an MR scanner.
HIFU is an FDA approved treatment with immediate results. It is not a surgery, there is no anesthesia, and you are awake during the procedure. If you have a tremor, why not ask your doctor if HIFU is right for you?
A note about DBS surgery and swimming: A study published by the American Academy of Neurology found that nine patients with PD who had undergone DBS surgery lost their ability to swim postsurgery.45 These patients had been proficient swimmers even after their PD diagnosis but found that their swimming skills deteriorated after surgery. If you plan to swim after DBS surgery, talk to your doctor. He or she may advise turning off the device prior to swimming.