Surgical treatment for Parkinson’s is a treatment offered to a person living with Parkinson’s who has responded well to medicine treatments and is noticing symptoms returning when medication levels are low – this is called a ‘motor fluctuation’. If you’re experiencing less reliable symptom control from medications or if a medication regime is complex, it may be time to discuss surgical options with a neurologist.
How surgery may help
Surgery for Parkinson’s can give some people better control of their symptoms, but it’s not a cure, so the condition will continue to progress. Most people will still need to take some medication.
Not everyone will be suitable for surgery, so you may want to discuss this option with your specialist. However, all surgery – including Deep Brain Stimulation – carries risk.
You may be referred to a consultant neurologist or surgeon at a hospital that performs surgery for Parkinson’s. If you’re a suitable candidate for surgery, there is a lengthy and comprehensive assessment to help ensure the best possible outcome.
Main type of surgery for Parkinson’s
The main type of surgery available for the treatment of Parkinson’s is:
Surgical treatment for Parkinson’s is continually advancing and for some people, it is an important way to treat symptoms of Parkinson’s.
Deep brain stimulation (DBS)
Deep brain stimulation, known as DBS, is the main type of surgery used to help manage the symptoms of Parkinson’s. Your neurologist will be able to discuss if you are a suitable candidate for DBS, or refer you to a neurologist with experience in Deep Brain Stimulation.
DBS is not a cure, and for some people, it is an effective way to manage motor symptoms, which respond to levodopa and return when medication is wearing off – this is sometimes called a ‘motor fluctuation’.
Motor symptoms improved with DBS can include slowness of movement, stiffness and tremor.
DBS treats the symptoms by stimulating parts of the brain lacking in dopamine. When it is working, it may also mean that someone can take less medication, reducing the risk of side effects, such as involuntary movements (dyskinesia) or unpredictable ‘off’ periods.
The long-term outcome of deep brain stimulation is very encouraging.
Who is suitable for DBS?
Not everyone will be suitable for DBS, and it won’t work for everyone who has the operation. If you have responded well to tablet-based medication you may be a suitable candidate. Discussing the options with your neurologist or a DBS specialist neurologist will help identify your suitability.
What does DBS involve?
DBS involves implanting leads, which have electrodes at the end, into specific site in the brain depending on the symptoms. Examples include:
- The thalamus (this procedure is known as thalamic stimulation)
- The globus pallidus (this procedure is pallidal stimulation)
- The subthalamic nucleus (this procedure is subthalamic stimulation).
The surgery may be conducted as ‘awake DBS’ or ‘asleep DBS’. There is no difference in the outcome whether the surgery is carried out awake or asleep.
The leads will be implanted into specific areas of the brain, depending on symptoms experienced.
If you are receiving ‘asleep DBS’, the neurologist and neurosurgeon will have a very precise map of your brain to identify where the leads are going to be placed. If you are having ‘awake DBS’, a small electric current will be sent through the leads to test how the person’s symptoms respond to stimulation, to make sure they have been put in the right place.
The leads are connected to extensions that are tunnelled under the skin behind the ear and down the neck. They are then connected to a neurostimulator (a device like a pacemaker), which is placed under the skin around the chest or stomach area. In ‘awake DBS’, this part of the procedure is carried out under anaesthetic.
Neurostimulator devices
There are two types of neurostimulator: A non-rechargeable and a rechargeable device.
On average, the battery lasts 3-5 years depending on the stimulator settings, but some may last longer before a replacement is needed.
Some people may have a device that contains a rechargeable battery. Someone with a rechargeable stimulator will be given and taught how to use a recharging unit.
The neurologist will turn the device on after the surgery and will start to identify the level of stimulation which will best assist with your symptoms.
This stimulation will change some of the electrical signals in the brain that cause the symptoms of Parkinson’s.
A specialist will program the stimulator using a small computer.
Adjusting the device
Someone with a device fitted will be given instructions on how to use their own programmer. This will allow them to adjust the stimulation (within a certain range) and check the battery life.
It may take 4 – 6 months following surgery to identify the best stimulation program to address your symptoms and to adjust Parkinson’s medication to best manage symptoms. Some people are able to stop taking medication following surgery, although they may need to be re-introduced in the future.
The stimulator will be adjusted to treat symptoms of Parkinson’s as the condition progresses in the same way medication is altered over time.
Follow up
The DBS team will see you regularly following surgery to identify the best stimulation program. How regularly you have stimulation adjustments will be determined by the DBS team. Once the best program has been identified, you will continue to see your neurologist. This may be the neurologist who was involved in the DBS team, or your regular neurologist. Manyu neurologists, even if they are not in a DBS team, are often able to adjust DBS.
Ask your doctor what changes you need to be aware of – both good and bad – and for a list of symptoms that may require an immediate response from your neurologist or neurosurgeon.
Pay attention to any behavioural, emotional, and cognitive changes after surgery. If you have any concerns or begin to feel unwell, contact your specialists immediately. You can also contact Fight Parkinson’s Health Team on 1800 931 031.
Everyday activities and travel
Most everyday activities are safe. However, welding is not safe nor is any activity where you’re exposed to strong electrical currents. There are also some sports that could damage the system.
If you’ve had DBS you can travel by plane, but you should inform airport security that you have a pacemaker-like device installed and carry a card that explains that you have had this type of surgery. This is important for security check points, and you should avoid metal detectors. Full body scans are generally safe, however you will still need to be manually checked.
You should also carry the hand-held programmer when travelling. This is in case the stimulator is accidentally switched off.
Useful tips
Make sure you make hospital staff and other healthcare professionals, including dentists and physiotherapists, aware if a neurostimulator has been implanted.
MRI scans, a type of brain scan, can only be used under very strict conditions. Antibiotics have to be prescribed when there is a risk of germs getting into the blood stream, for example during dental procedures or surgery.
Diathermy is the use of a high frequency electronic current to produce heat and is often used to relax muscles. It should not be used on someone who has had DBS.
People who have had DBS, have reported difficulties in coordinating movement when swimming. Following DBS, swimming alone should be avoided.
The future of surgery for Parkinson’s
There are currently many unanswered questions about surgery for Parkinson’s, and more research is needed.
Right now, researchers are unsure how long any benefits may last or whether any types of surgery may delay the progression of Parkinson’s.
Another possibility is that the best symptom control may come from using a range of different types of surgery. This needs to be addressed in future clinical trials.
Other future options for surgery, which currently remain experimental, are aimed at replacing and/or restoring the dying dopamine cells.
There have been many exciting developments in surgical treatment for Parkinson’s in recent years and the future looks promising.
Learn more about current research we are funding to find new and better treatments and a cure.
Important information
If you’re looking into whether surgery is right for you, it’s important you fully understand the procedure involved, the possible benefits and potential risks. Write down any questions you have and take these along to discuss with your specialist or surgeon.
