Working Together to Identify the Ideal Deep Brain Stimulation Candidate

Movement disorders –including Parkinson’s disease, an illness that causes brain cells in an area of the brain to die–show no social, ethnic, economic or geographic boundaries. As our population ages, South Florida clinicians and psychosocial support specialists are treating an increasing number of patients with these diseases.

It is believed that 60,000 new cases of Parkinson’s disease are diagnosed in the United States each year, and at least one million people are affected. While there is an alarming increase of young onset patients, the frequency of this disease is considerably higher in people over 60 years of age. There are no current statistics available, but Florida is considered to be one of the most prevalent regions because of its older population.

Treatment Options

Combined treatment approaches –lifestyle modifications, physical and speech therapy, medication, and neurostimulator implants–are widely used and are shown to help reduce troubling symptoms.

The most common treatment for Parkinson’s disease is prescription medications that elevate the levels of dopamine in the brain to improve motor functions. There is no cure for the disease, and there are no current treatments available to slow or stop the progression of movement disorders.

DBS therapy delivers small electrical pulses to precisely targeted areas within one or both sides of the brain to help patients achieve greater control over disabling body movements. Photo courtesy Medtronic, Inc.

Well managed, drug therapies can help many patients maintain a good quality of life. However, long-term use of Parkinson’s medications can cause motor fluctuations called "on-off response." During an "on" period, a person can move with relative ease. "Off" periods usually present with involuntary twitching and movements called dyskinsias. On-off periods can be managed with changes in medications. However, when medication adjustments do not improve mobility, or when medications cause significant side effects, surgical treatment may be reasonable consideration.

Specialty-trained neurological surgeons are now able to offer an advanced surgical treatment called deep brain stimulation (DBS) to patients with movement disorders. DBS surgery involves placing a thin metal electrode into one of several possible brain targets and attaching it to a computerized pulse generator, which is implanted under the skin in the chest. DBS does not destroy brain tissue. Instead, it reversibly alters the abnormal function of the brain tissue in the region of the stimulating electrode.

The Ideal DBS Candidate

When identifying a Parkinson’s disease patient for DBS, it is important that the neurologist and neurological surgeon work together early in the diagnosis to project the best future timeframe for treatment. The best time is neither at the onset of Parkinson’s disease nor after all medication dosages and combinations have stopped working. The ideal DBS candidate will:

• Be 70 or younger;
• Responding to prescription medication at least for short periods but still having difficulties controlling or initiating movements;
• Be in good general health;
• Have normal intellectual and memory function for his or her age; and
• Currently require medication more than three times a day to remain "on."

A new community-based DBS program is being offered by Miami Neurological Institute (MNI) in Aventura. As part of the program, MNI neurological surgeons collaborate with South Florida neurologists to identify candidates who are most likely to benefit from DBS. Post-surgery, MNI’s specialty trained staff works with referring neurologists both remotely and at their practice location to monitor, connect, and adjust the patient’s device to alter the intensity of stimulation and continually improve control of symptoms.

While DBS is not a cure, it offers hope to Parkinson’s disease patients to better control involuntary movements for controlled symptoms. Many people report feeling as though their life clocks have been turned back after DBS. Together, neurologists and neurological surgeons have the power to make a difference in these patients’ lives.