Brain pacemaker for Parkinson’s

Posted on 5 November 2012

Dr Roger Melvill, a neurosurgeon at Mediclinic Constantiaberg, is bringing hope to sufferers of Parkinson’s disease for whom medication is doing little to reduce their symptoms, with a procedure known as deep-brain stimulation (DBS).

I have been struggling with tremors and have now been diagnosed with Parkinson’s disease. What does that mean?
Tremors are often the first noticeable symptom of Parkinson’s disease, and goes along with the classic symptoms of rigidity, slowness of movement (bradykinesia) and difficulties with balance. Parkinson’s gets worse over time, affecting all the muscles in the body, which can lead to difficulty swallowing or speaking, or constipation, for example. But this usually happens slowly over many years, and good treatments are available that could help you lead a full life.

Why did I get Parkinson’s disease?
Parkinson’s disease affects your movement due to the loss of cells in various parts of the brain, causing your central nervous system to degenerate. No-one knows for sure why your cells break down. It could be that you inherited abnormal cells genetically, but it could also be brought on by age or environmental factors. What we do know is that it affects one in 100 people over the age of 60, but it can occur in people as young as 30.

What is my outlook?
Parkinson’s is a chronic progressive disease but it isn’t fatal. At this stage there is no known cure, yet you can improve your quality of life through eating well, living well, medication, educating yourself on the disease and getting good support.

And then there are surgical procedures, such as DBS, which can reduce symptoms.

So what is DBS?
Deep-brain stimulation is a procedure that involves placing a tiny brain pacemaker into the area of your brain that has been affected by cell loss. Here it sends out electrical impulses that can have a remarkable effect on symptoms such as tremors, rigidity and slowness of movement. It also means less reliance on medication, and the pacemaker can be adjusted as the disease progresses.

What happens during a DBS procedure?
The first step is to find out exactly where in your brain has been affected. This is done using magnetic resonance imaging (MRI) and computed tomography (CT) scans, and a lightweight stereotactic frame that is placed on your head to give an external reference point.
• A small hole is then drilled into your skull under local anaesthetic. This may sound freaky but you won’t feel anything and it is only the sound that some find disconcerting.
• An electrical stimulus is sent via a probe to the affected area. Because you’re awake during this procedure, the effect on symptoms is immediate and the doctor is able to tell whether the stimulus is in the right place.
• A permanent electrode is put in place and then, under general anaesthetic, connected to a pacemaker inserted under skin of the chest.

Can anyone have DBS?
Many patients who do have the surgery derive significant benefit in respect of their motor symptoms. However, DBS is not recommended for every patient. It’s generally considered only when medication no longer brings adequate relief, and after thorough evaluation by a team of neurological specialists.

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The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.