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Dr. Okun

How long do the effects of DBS Last?

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It is not the end of the road.

 

The rule is that DBS helps medication responsive symptoms (dopamine responsive) but as the disease progresses and the symptoms are less responsive so to is DBS. The exceptions are tremor and dyskinesia which in most cases continue to respond well.

 

Here is a recent article and this device as to what DBS improves is included in the NPF booklet.

Neurologist. 2004 Sep;10(5):290. Links

A mnemonic for Parkinson disease patients considering DBS: a tool to improve perceived outcome of surgery.

 

Okun MS, Foote KD.

Department of Neurology, Movement Disorders Center, University of Florida McKnight Brain Institute, Gainesville, Florida 32610, USA. okun@neurology.ufl.edu

Patients considering deep brain stimulation (DBS) for Parkinson disease (PD) may be exposed to videotapes, media coverage, or literature which show dramatic improvements in PD symptoms after surgical intervention. Based on this information, patients may seek a medical center with expertise in DBS for an evaluation and assessment of their candidacy for surgery. If patients receive a device, they may be disappointed or despondent following surgery because of a failure to achieve a preconceived and unrealistic outcome. In order to address the important issue of patient misconception of potential outcome, we have introduced a simple mnemonic device. The device may be taught and then reviewed with patients and families both before and after surgery. Use of this mnemonic device may allow the patient and family the time necessary to alter the perception of perceived benefit. This education can help to ensure that outcome meets or exceeds expectation, and as a result they become a more satisfied and easy-to-manage DBS patient.

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One would expect from dbs to have a significant reduction in the general stiffness - you might say the "brakes being on all the time" problem that is so obvious with PD. My question is - does dbs have any effect on the other problems associated with PD such as drooling, constipation, and balance? I would expect speech to be improved. But dopamine improves so many symptoms. Just how many of these are also improved by dbs?

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In general, the safest predictions still lie in what improves with levodopa improves with DBS; however remember disease progression will kick in after DBS and the equation for an individual patient may change.

 

Speech usually worsens post-DBS.

 

The other features particularly balance and gait usually slowly worsen post-DBS (disease progression but sometimes the surgery too).

 

We don't expect drooling and constipation to improve but sometimes they do.

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Guest TonyaV

Although I know the disease does continue to progress after DBS, my perception was that the effectiveness of DBS was would stay the same when it is turned on. I know this sounds ignorant, but it sounds like you're saying DBS will lose it's effectiveness over time. Does the disease progression slow down with DBS or are the symptoms just hidden/masked with DBS? Is there evidence of a slower progression over time when the device is turned off? I'm thinking why go to the trouble of invasive surgery. Is it really worth the risk in the long run?

I'm sorry if these questions have already been asked and answered. If so, could you point me to the specific post/posts?

Thank you, Dr. Okun.

 

Tonya

 

 

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This is a very good question.

 

There is no solid evidence that DBS is neuroprotective and saves neurons. However, there has been some work suggesting a mild disease modifying effect (Wallace and Benabid).

 

We do not recommend DBS as a cure or neuroprotective currently and the benefits of early implantation are currently under investigation.

 

In PD, the effects of DBS on rigidity, bradykinesia, gait and balance last only as long as these symptoms remain levodopa responsive. Some of these symptoms my be enhanced for very long periods of time, but usually not better than the best medication "on." The on-off fluctuation improvement, dyskinesia improvement, and tremor improvement seem long-lasting with well placed leads.

 

In short DBS is a very effective symptomatic therapy in the right well-selected patient.

 

Over the years I have been impressed in the patients who have told me their disease progressed and they were not sure if DBS was still working......well, many of them have attempted to turn the battery off or to let it run out and you would not believe the realization of how important that DBS still was...even later into the disease. Again, a powerful symptomatic therapy is the message.

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Guest TonyaV

Thank you, Dr. Okun.

 

You answered my questions perfectly. I now understand and this has helped me in making a decision about DBS.

 

Tonya V.

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Thank you, Dr. Okun.

 

You answered my questions perfectly. I now understand and this has helped me in making a decision about DBS.

 

Tonya V.

Assymetry in involvement, that is, one side is involved more than the other side of body is one of the criteria in favor of PD (Paralysis Agitans).

Dr. Birkmayer (the clinical counterpart of the pharmacologist Dr. Hornykiewicz in the original discovery of L-DOPA therapy in Wien, Austria) noticed

"The patient with PD does not die as the result of [cogwheel-type of] rigidity, he dies because of his akinesia".Life for parkinsonian patients

has become increasingly mobile and therefore more livable since the introduction of L-DOPA therapy 50 years ago. And, the akinesia is the most responsive

PD criterion to L-DOPA therapy. The least responsive criteria are the rest-tremor and postural imbalance, respectively. So it seems that DBS would be most valuable in treatment of right sided tremor (in right handed person).

gmk

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DBS is great for tremor and especially those medication resistant tremors. Agree DBS is not good for axial resistant symptoms.

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