Cleveland Clinic

Deep Brain Stimulation for Parkinson’s Disease

Helps Patients Regain Control

An increasing number of Bahamians are being diagnosed with Parkinson’s – the second most common neurodegenerative disease after Alzheimer’s.

“We are seeing more people presenting with it. Some of that is due to awareness on the part of family members, ‘Internet doctors’ searching symptoms online,” said Dr Edwin Demeritte, chief physician at the Bahamas Neurological Centre and one of three neurologists in The Bahamas. “It’s the tip of the iceberg though. I think there are a lot more who are out there,” he adds, admitting hard statistics are difficult to come by. There is no public registry and research into the disease is sorely lacking.

One of the most important things when suspecting a serious disease is knowing how to identify early signs for it. Equally as important is seeking a medical consultation to confirm whether or not what one is experiencing is what’s suspected. For a disease like Parkinson’s, which is difficult to identify in its early stages, knowing exactly what to look for and how to react is imperative.

Parkinson’s disease is a chronic progressive neurological disease that affects nerve cells (neurons) in the brain. As a progressive disease, Parkinson’s destroys the brain’s nerves from the bottom up. Symptoms for Parkinson’s include tremors (rhythmic movement of lips, chin, hands and legs); rigidity; stiffness and slowness; as well as balance and gait problems.

Dopamine is usually lacking in the brain or not produced sufficiently in people with Parkinson’s disease. To help manage symptoms, patients may take levodopa, a pill that is converted to dopamine when it reaches the brain. It is often prescribed with a second drug called carbidopa, which offsets nausea effects caused by levodopa alone.

As an alternative, doctors also may use deep brain stimulation to treat patients who don’t get relief with medication. Deep brain stimulation is a way to electrically modulate parts of the brain that are responsible for the movements caused by Parkinson’s disease. In deep brain stimulation, electrodes are placed in the subthalamic nucleus or globus pallidus . The electrodes are connected by wires to an implantable pulse generator (IPG), a type of pacemaker device placed under the skin of the chest below the collarbone.

Once activated, the IPG sends continuous electrical pulses to the target areas in the brain, modifying the brain circuits that are responsible for the motor symptoms of Parkinson’s without permanently changing parts of the brain. Patients are given a simple programmer to turn the IPG on or off, check the lifespan of the device, or choose between different preset functions based on their symptoms and needs.

Dr Badih Adada, a neurologist at Cleveland Clinic Florida, explains the benefits of Deep Brain Stimulation for Parkinson’s patients.

“A key differentiator with deep brain stimulation is that it does not damage any part of the brain and also has fewer complications than other kinds of surgery. Adjustments can be made as the person’s disease changes without additional surgery and can be turned off if excessive side-effects occur, without any long-term consequences. Over 70% of patients who undergo this procedure show significant improvement of all related symptoms.”

“Everyone’s experience with Parkinson’s is unique,” says Dr Adada. “It’s important to get a good evaluation by a neurologist or Parkinson’s expert to make sure you’re on the right path.