According to the Northwest Parkinson's Foundation, about one hundred thousand people in the Northwest alone are affected by Parkinson's Disease.
At EvergreenHealth, significant progress has been made through the use of Deep Brain Stimulation to reduce or eliminate the symptoms of Parkinson's.
Neurosurgeon Doctor Peter Nora and advanced nurse practitioner Kristen Crosley specialize in the treatment of movement disorder patients explain more about this treatment.
What is deep brain stimulation (DBS) and what is it used for?
Dr. Peter Nora: DBS is an increasingly common surgical procedure that offers patients living with neurological conditions – like Parkinson’s disease– a promising treatment option when medications alone aren’t able to control patients’ physical symptoms.
The procedure involves placing tiny wires, or electrodes, within certain areas of a patient’s brain, which work to block abnormal nerve signals that cause tremor and other Parkinson’s symptoms.
The electrodes are controlled by a battery-operated device called a “neurostimulator” – similar to a heart pacemaker – which is surgically placed under the skin in a patient’s chest, to send electrical stimulation to the targeted areas in the brain that control movement.
Patients are able to adjust the level of stimulation as needed for their symptoms, and importantly, the procedure does not damage healthy brain tissue.
How long has the technology been used, and how long have you been doing it?
Kristen Crosley: DBS was first discovered in the late 1980s, and has been used for nearly two decades for treating patients with Parkinson’s.
Today, more than 125,000 people in the U.S. are living well with DBS electrodes implanted in their brains.
Most recently, the FDA approved DBS as a treatment for severe forms of OCD, as well.
Dr. Nora is a leader in this practice area and has focused on specializing in DBS throughout his 20-year career.
You specifically focus on Parkinson’s— how exactly does this treatment work for that disorder, and how effectively are normal versus abnormal nerve signals detected?
Dr. Nora: Patients suffering from Parkinson’s commonly experience tremors, rigidity, stiffness, slowed movement and walking problems.
DBS sends electrical impulses to areas in the brain that control movement, which effectively block abnormal nerve signals and prevent these motor symptoms.
The procedure is actually performed while the patient is awake under local anesthesia so that surgeons can interact with the patient to gauge the electrodes’ effectiveness as they’re placed throughout the brain.
Who is a candidate for DBS treatment for Parkinson’s? Are there risks involved?
Dr. Nora: DBS typically is a viable treatment option for people who have had Parkinson's for at least four years and experience a benefit from medication, but still have motor complications.
DBS works best to lessen motor symptoms like stiffness, slowness and tremor.
It doesn't work as well for imbalance, freezing when walking or non-motor symptoms.
DBS may even exacerbate thinking or memory problems so it's not recommended for people with dementia.
DBS is generally regarded as low-risk, with just a 1 percent rate of complication, typically from excess bleeding, which in very rare cases can lead to damage of the brain.
Still, the risks of brain surgery are important to understand, which is why the practice uses rigorous screening tools to determine patients’ eligibility.
Good candidates share some of these attributes:
What can a Parkinson’s patient expect after DBS?
Kristen Crosley: I'm an experienced nurse practitioner and I work exclusively with Dr. Nora to help manage treatment for patients with movement disorders. I'm responsible for working with patients and families to coordinate pre- and post-operative clinical procedures for DBS device programming.
Immediately following the electrode procedure, patients will stay in the hospital for one night, and will receive a CT scan or MRI after the surgery to confirm the location of the electrode(s) and to check for any post-operative bleeding.
About three to four weeks after surgery, patients return for “programming” so doctors can set and adjust the strength and frequency of the electrical stimulation and modify medication dosages.
During the first three months after the procedure, patients make regular follow-up visits to an outpatient clinic to make any necessary adjustments.
Most patients notice immediate improvement – sometimes within 10-15 seconds of passing the first low-level current to the electrodes, tremors can become less pronounced.
As their symptoms improve, many patients report having more independence and an overall better quality of life.
Dr. Peter Nora is a board-certified neurosurgeon with EvergreenHealth Spine & Neurosurgical Care, and is one of the region’s leading specialists in treating comprehensive neurological disorders and spine disease. His practice focuses on deep brain stimulation (DBS) surgery for movement disorders, and his experience includes roles as principal investigator in several clinical studies focused primarily on utilizing deep brain stimulation to treat neurological disorders such as Parkinson’s disease.
Kristen Crosley is a board-certified advanced nurse practitioner who works with Dr. Nora to help manage patients with neurological conditions. Her expertise is in the treatment of movement disorder patients with DBS. She has coordinated DBS device programming for the treatment of Parkinson’s Disease, Essential Tremor and Dystonia for over 300 patients in the last four years.