Who is a good candidate for Deep Brain Stimulation Surgery for Parkinson's Disease

In the clinic I often get asked the question "Who is a good candidate for Deep Brain Stimulation Surgery?" As Parkinson’s Disease worsens with time, the patient may notice that the benefit from the medicine doesn’t last until the next dose, this is called “wearing off”. When the medication wears off, symptoms including tremors, sluggishness, and difficulty walking may return. When the medication is taken again the symptoms improve and the good period is called an “ON” period while the bad period is called “OFF”. Patients may also develop involuntary movements (twisting and turning) called dyskinesias usually as a side effect of increased doses of these medications, which may be troublesome.

DBS may be an option when a PD patient continues to benefit from treatment but still experiences terrible OFF periods and/or troublesome dyskinesias, despite modifications in drug doses. Patients with severe memory issues, hallucinations, severe depression, and noticeable instability/imbalance when walking even when ON may not be good candidates.

Any patient with Parkinson's Disease who fulfils the following criteria can be offered DBS Surgery.

• Parkinson's Disease for more than four years.

• Symptoms responsive to Levodopa - carbidopa (Syndopa / LCD / Sinamet / Syncapone)

• Experience severe tremors and dyskinesias (involuntary movements of the face, arms, legs, or trunk) or significant motor fluctuations

• Encounter intense motor fluctuations that cannot be managed by altering medication schedules

• Frequently encounter notable dyskinesias mixed with rapid wearing off and off-time crises during the day

• No major gait issues in the ON Phase.

• No balance problems

• No cognitive issues

• Have a good support network of family and friends who can be involved in learning about the DBS system and process 

Symptoms that respond well to DBS include:

• Tremor

• Stiffness

• Bradykinesia (slowness of movement)

• Dystonia (sustained or repetitive muscle twisting, spasm or cramp

• Dyskinesia

Reasons why someone may not be an ideal candidate for DBS include:

• Not having typical Parkinson's

• Not responding well to levodopa

• Has severe dementia, apathy, depression, poor health and poor family support.

Not all individuals are suitable candidates for this surgery. It's crucial to understand that certain Parkinson's symptoms respond effectively to DBS, while others do not. The choice to proceed with surgery relies on a careful evaluation of each person's particular symptoms.

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Testimonial of patient who underwent DBS Surgery