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Harvard Reviews of Health News

Benefits of Device Persist for Parkinson's

Improvements from a brain implant treatment last for at least 3 years in people with Parkinson's disease, a follow-up study finds. The study focused on treatment with deep brain stimulation. This involves implanting a device inside the brain. It uses current from a battery to stimulate one area of the brain. The study included 159 people. They were randomly divided into two groups. One group had the device implanted in an area called the subthalamic nucleus (STN). The others got the implants in a less-studied area called the globus pallidus interna (GPi). Both groups had similar improvements in symptoms such as tremors, muscle tone and speech. The follow-up found that people were still doing better 3 years after surgery. People receiving stimulus to the GPi region also had improvements in thinking and learning abilities. The journal Neurology published the study online. HealthDay News wrote about it June 20.

What Is the Doctor's Reaction?

In our hospital, doctors place orders by computer. I cannot order an MRI unless I first answer this question: Does your patient have a deep brain stimulator?

I knew the reason for the question. Certain types of metal in the body can move and cause trouble if exposed to the powerful magnet in an MRI scanner. But, for the longest time, I'd never heard of a patient having such a thing. I wasn't even sure what it was or why a patient would have one.

In recent years, I've learned a bit about them:

  • Deep brain stimulators are tiny wires that have been inserted into certain parts of the brain. They are powered by batteries.

  • The U.S. Food and Drug Administration has approved brain stimulators to treat a few conditions. They include: 

    • A type of involuntary shaking called essential tremor

    • Parkinson's disease

    • A movement disorder called dystonia

  • Deep brain stimulation has shown promise in treating several other conditions. These include:

    • Chronic pain

    • Depression

    • Tourette syndrome

  • Although the treatment is considered safe, deep brain stimulation does have some downsides:

    • The usual risks of surgery (pain, bleeding, infection and other possible problems)

    • Stroke or seizure

    • The need for repeated, minor surgery to replace the battery or the wires

    • A sensation of being shocked or jolted

    • The high cost of the surgery

Despite these potential problems, deep brain stimulation can be remarkably effective. And a new study finds that the benefits can last.

Researchers report that movement problems related to Parkinson's disease improved by about 32% after deep brain stimulators were inserted into a region of the brain (called the globus pallidus interna). This benefit was maintained for more than 3 years. The medical journal Neurology published the study results online.

Declines in mental function also slowed. When the stimulator was in a different brain area (called the subthalamic nucleus), movement improved to a similar degree. However, there was not a similar improvement in thinking skills.

This study is important because Parkinson's is a common disease that can affect activities of daily life. It causes slowed movements, and dementia often develops over time. Because there is no cure, we need treatments that work for a long time.

The role of deep brain stimulation is still evolving. But this study is among the first to show that the benefits of deep brain stimulation can last for years and that it may be able to slow decline in thinking skills.

What Changes Can I Make Now?

If you or someone close to you has Parkinson's disease, deep brain stimulation may be an option worth considering. Your doctors are unlikely to recommend this approach for mild symptoms. But it may help reverse more severe symptoms over the long term. As this new research shows, it also may help delay dementia in someone with Parkinson's disease.

Know all of your treatment options, including:

  • No treatment – This is usually the best approach only when symptoms are minimal.

  • Medicines – Several medicines can be effective. They include: 

    • Levodopa (Larodopa, Dopar)

    • Carbidopa-levodopa (Sinemet, Madopar)

    • Bromocriptine (Parlodel)

    • Pramipexole (Mirapex), ropinirole (Requip)

    • Selegiline (Eldepryl) or rasagiline (Azilect)

    • Biperiden (Artane, Cogentin), orphenadrine (Norflex) and procyclidine, amantadine (Kemadrin)

  • Physical activity – Exercise can increase mobility and improve strength and balance. All of this may reduce the risk of falls and improve mood and overall function. Working with a physical therapist may be helpful.

  • Treatment for depression – Depression is common among people with Parkinson's disease. Treatment with counseling, antidepressant medicines or other approaches can be a big help.

Deep brain stimulation and other surgical options may be offered if these treatments are not effective.

What Can I Expect Looking to the Future?

You can expect researchers to come up with new treatments for Parkinson's disease. This will likely include new insights about brain stimulation. We still need to know which people are most likely to benefit, which parts of the brain should be stimulated, and why it's effective. I think the number of conditions treated with deep brain stimulation will continue to increase.

Deep brain stimulation still seems like a strange way to treat a brain disease. But someday it could become commonplace.

Author: Robert Shmerling, M.D.
Date Last Reviewed: 6/21/2012
Date Last Modified: 6/21/2012