Deep Brain Stimulation for Parkinson’s May Help Long Term

By Steven Reinberg
Health Day reporter

THURSDAY, June 3, 2021 (HealthDay News) – Parkinson’s disease patients can achieve symptom relief with long-term deep brain stimulation (DBS) therapy, according to a new study.

Over 15 years, patients who received DBS, which requires surgical implantation, experienced significant improvement in motor symptoms and less need for medication, the researchers found.

“Our study, for the first time, supports the efficacy of deep brain stimulation in the very long term – 15 years after surgery and 25 years since diagnosis of Parkinson’s disease,” said senior researcher Dr Elena Moro, director of the movement disorders unit at Université Grenoble Alpes in France.

“Indeed, after an average of 15 years after surgery, patients might feel an improvement compared to before surgery,” she said. “In addition, there was still a marked reduction in anti-parkinsonian drugs and an improvement in quality of life, compared to before the procedure.”

Patients with Parkinson’s disease no longer produce dopamine, which affects their speech, walking and balance. Symptoms can be partially relieved by the drug levodopa, which temporarily restores dopamine.

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But as dopamine levels fluctuate throughout the day, patients can experience dyskinesia, a side effect of levodopa that can cause the head to twist, sway, or move.

Deep brain stimulation uses electrodes placed in areas of the brain to control symptoms of Parkinson’s disease. The electrodes connect to a pacemaker-like device placed under the skin in the upper chest that transmits an electrical pulse that helps control symptoms. Many patients use a handheld controller to adjust stimulation levels as needed.

For the study, Moro’s team collected data on 51 patients treated with DBS. On average, they have had the device for 17 years.

Compared to pre-implantation data to those after 15 years, the number of times patients experienced dyskinesia was reduced by 75%. The use of drugs to control dopamine levels was reduced by 51%, and the time that drugs were no longer working well dropped by 59%.

Researchers found few side effects associated with using the device for 15 years, and these were mostly manageable.

DBS is recommended for advanced Parkinson’s disease, and Moro said surgery should not be delayed when motor conditions and quality of life decline despite other treatment.

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“This information is relevant to doctors, patients and their families when deciding on the surgical option to treat Parkinson’s disease,” she said. “People with Parkinson’s disease should know that the beneficial effects of deep brain stimulation surgery will last beyond 15 years.”

Parkinson Foundation national medical adviser Dr Michael Okun said that DBS, when used with medication, has long lasting effects in some patients. He was not part of the study.

“These long-term studies tell us a number of things,” said Okun, president and professor of neurology at the University of Florida. “The most important thing they tell us is that the disease continues to progress despite the procedure.”

Neither deep brain stimulation nor medication is a treatment for the disease itself. “Where you get long-term benefits are things like dyskinesias and motor fluctuations,” Okun said.

Patients who do well on levodopa are the most likely to benefit from DBS, he said.

Patients who still benefit from the device after 15 years are those whose disease progresses slowly. People whose Parkinson’s disease progresses more quickly aren’t there for evaluation after 15 years, Okun said.

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“We have people in our practices who have had Parkinson’s disease for 30 years or more,” he said. “The real lesson in deep brain stimulation is choosing the people who have a good response to levodopa before you implant.”

DBS is not good for walking, talking, thinking and balancing, Okun said.

“In the long run, it helps smooth out fluctuations, suppress shaking and jerking,” he said. “It’s hopeful for features that still respond to dopamine, so if your stiffness or stiffness still responds to dopamine, that’s fine.be useful. This is where he has his biggest bang in 15 years. “

Okun stressed again that Parkinson’s disease progresses no matter how it is treated.

“What we’ve found in the deep brain stimulation populations is that they’re still prone to dementia, so they’re still like normal people with Parkinson’s, they’re still having trouble walking,” of speaking and thinking, and these things are not handled well by this material solution, ”Okun said.

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The results were published online June 2 in the journal Neurology.

More information

To learn more about the treatment of Parkinson’s disease, visit the Parkinson Foundation.

SOURCES: Elena Moro, MD, PhD, director, Movement Disorders Unit, Université Grenoble Alpes, Grenoble, France; Michael Okun, MD, national medical adviser, Parkinson Foundation, and president and professor of neurology, University of Florida, Gainesville; Neurology, June 2, 2021, online

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