Who Can Benefit from Deep Brain Stimulation

Patients who no longer benefit from or are unable to tolerate medications and who have reduced quality of life may be candidates for deep brain stimulation.

The U.S. Food and Drug Administration approved Medtronic's Activa DBS system for tremor in 1997 and for Parkinson's disease in 2002. The FDA approved DBS for primary dystonia in 2003 and for Obsessive-compulsive Disorder (OCD) in 2009 under Humanitarian Device Exemptions. Although generally less effective, DBS can be used for secondary dystonia, caused by an illness, medications, stroke or trauma, as an off-label indication.

Appropriately selected patients can benefit dramatically from DBS. Benefits of DBS include the fact that it is both adjustable and reversible. Should new therapies become available in the future, patients can have the DBS system removed and try newer treatments. If a patient is not an appropriate candidate for DBS, an alternative procedure such as pallidotomy or thalamotomy may still be possible.

The Henry Ford Parkinson's Disease and Movement Disorders program provides a thorough evaluation of every candidate for DBS. This includes appropriate pre-surgical testing from our multi-disciplinary team (neurology, neurosurgery, neuropsychology, and specialized nursing services). The eligibility of each patient is thoroughly reviewed and informed consent is provided in detail.

If you have Parkinson's Disease, it is reasonable to consider deep brain stimulation if you:

  • Truly have Parkinson's disease without evidence for an alternative "Parkinson-plus" disorders
  • Respond to levodopa (Sinemet, Stalevo), but medication is not working as well as it used to due to fluctuations in movement. Doses do not kick in and give you relief or you have extra movements related to medication dosing (levodopa-induced dyskinesias). By the time most of our patients are considering surgery, they are taking levodopa every 3 hours while awake.
  • Have disabilities that are likely to improve from DBS, i.e., slowness of movement (bradykinesia), rigidity, tremor, levodopa-induced dyskinesias, motor fluctuations and/or contractions when off medication ("off "dystonia)
  • Have such advanced Parkinson's that you are wheelchair bound or falling frequently
  • Are less than 80 years old
  • Don't have dementia
  • Don't have significant psychiatric disease related to your Parkinson's Disease
  • Don't have other medical problems that might make surgery too risky, e,g,, bad heart disease, need to be on blood thinners
  • If you have Essential Tremor, it is reasonable to consider DBS if you:
  • Have tremor that interferes with your quality of life (difficulty shaving, eating, writing, talking, social embarrassment)
  • Have tried the following medications without adequate relief of your tremor: propranolol (Inderal), primidone (Mysoline), topirimate (Topamax), methazolamide (Neptazane), clonazepam (Klonopin)
  • Don't have other medical problems that might make surgery too risky, e,g,, bad heart disease, need to be on blood thinners

If you have dystonia, it is reasonable to consider deep brain stimulation if:

  • It interferes with your quality of life
  • You have not gotten adequate relief or are not a candidate for treatment with levodopa (Sinemet), botulinum toxin (Botox, Dysport, Myobloc, Xeomin), trihexyphenidyl (Artane), benztropine (Cogentin), clonazepam (Klonopin) and baclofen (Lioresal)
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