Neurological Awareness
The Beginning of a Journey: Behind a Trembling Hand
Mrs. Ayşe is 59 years old. While her grandchild is taking their first steps, she notices a slight tremor in her hands. Initially she dismisses it as “just aging,” but the trembling grows over time. She finds it difficult to tie her shoelaces or even carry a teacup. She does not yet realize that this small tremor is the first whisper of Parkinson’s disease, which will gradually cast a shadow over her life. One morning, sitting at the breakfast table in quiet despair, she wonders if there is “any solution at all?” Actions she once performed with ease become struggles, social situations become sources of anxiety, and hope—most mornings—takes on a grey shade. It is at this dark moment that deep brain stimulation emerges as a stubborn light. This article offers a comprehensive look at when and for whom deep brain stimulation (DBS) in Parkinson’s can be a beacon of hope, and how it works.
Understanding Parkinson’s Disease
Parkinson’s disease is a progressive, chronic neurodegenerative disorder that affects the central nervous system. Its most prominent symptoms are slowness of movement (bradykinesia), muscle rigidity, resting tremor (hand shaking), and postural instability (balance problems). It is estimated that over 10 million people worldwide have Parkinson’s disease. The risk increases with age and it’s typically diagnosed in individuals over 60.
The disease’s symptoms are caused by a deficiency of the neurotransmitter dopamine in a brain region called the “substantia nigra.” Dopamine is crucial in transmitting messages between the brain and muscles. As the dopamine-producing cells are gradually lost, movement control becomes increasingly difficult.
Standard Treatment: Why Isn’t It Always Enough?
The cornerstone of Parkinson’s treatment is medication, such as levodopa and dopamine agonists. These drugs help manage symptoms by compensating for low dopamine levels. However, after several years, medications may lose their effectiveness or the patient may experience "on-off" phenomena—a fluctuating state where movement becomes suddenly difficult, followed by brief periods of relief.
According to 2023 data, approximately 40-60% of patients face “motor fluctuations” after 5 years (Parkinson Foundation).
In advanced-stage Parkinson’s, "dyskinesia" (uncontrolled movements) and "on-off" attacks can make everyday life significantly harder.
So, what if medications are no longer effective? Many like Mrs. Ayşe begin searching for alternative solutions at this stage. That’s where Deep Brain Stimulation (DBS) comes in.
What Is Deep Brain Stimulation (DBS)?
Deep Brain Stimulation (DBS) is a treatment in which thin electrodes are placed in specific areas of the brain to deliver mild electrical impulses, thereby controlling motor symptoms. DBS is performed using a device often called a brain pacemaker, and is one of the most evidence-based surgical approaches for Parkinson’s patients whose symptoms are resistant to medication.
DBS can improve quality of life in about 90% of Parkinson’s patients who undergo this surgical treatment (NCBI, 2009).
The main brain regions where electrodes are placed include:
Subthalamic Nucleus (STN): The most commonly targeted area.
Globus Pallidus Interna (GPi): Preferred especially for dyskinesias.
Thalamus (Ventrolateral nucleus): Used in specific cases where tremor is the dominant symptom.
Who Is Eligible for DBS?
Deep Brain Stimulation is not suitable for every Parkinson’s patient. The surgical decision requires a multidisciplinary assessment. So, which patients may be candidates for DBS?
Partial or Insufficient Control with Medication: If “on-off” fluctuations or severe dyskinesias occur despite treatment.
No major vascular lesions detected on brain MRI: A history of bleeding or infarct may preclude surgery.
Cognitive Function: No dementia or significant memory impairment.
Stable Psychiatric Status: To be postponed if there is severe depression or psychotic disorders.
Young-onset (Slow Progression) Parkinson’s: Young, medication-resistant patients may benefit more from surgery.
Criterion | Eligible for DBS? |
|---|---|
Age | Generally under 70 (but case-by-case decisions are made) |
Duration of disease | Usually at least 4-5 years of disease history |
Cognitive status | If no dementia |
Psychiatric profile | If no severe depression or psychotic disorder |
Motor response | Good response to medication (but rapid fluctuation or side effect) |
When Should DBS Be Considered?
One of the most important questions is, “When is the optimal time for DBS?”
DBS is generally recommended in these scenarios:
Medication is becoming less effective and “on-off” periods (uneven good/bad hours) are increasing
There is clear benefit from levodopa, but motor side effects (dyskinesia) are disturbing
Medications can’t be tolerated (e.g. psychosis, hallucinations)
In the early stage of disease, while cognitive and physical capacity are still good
A 2020 meta-analysis published in Lancet Neurology recommended the “optimal time” for DBS as the period after an average of 7 years, when medication-resistant motor complications begin. Early DBS has been shown to provide even greater benefits in some cases, but this is always an individualized decision.
Benefits and Expectations of DBS
DBS can provide significant benefits in controlling the motor symptoms of Parkinson’s (tremor, muscle rigidity, slowness, and dyskinesia). Research shows:
Up to 60% improvement in “on-off” fluctuations with levodopa
Over 70% reduction in tremor and involuntary movements
Noticeable improvement in daily living activities (NCBI study)
Possible 30-50% reduction in medication dosage
On the other hand, DBS may not be effective for cognitive problems, balance, or walking difficulties. Its benefits are usually more pronounced in the first few years; over time, as the disease progresses, the benefit may decrease.
How Is DBS Surgery Performed?
DBS is planned collaboratively by neurosurgeons and neurologists. The typical procedure involves:
Candidate selection: Comprehensive neurological and psychiatric assessment.
Electrode implantation: Under local or general anesthesia, electrodes are placed in precisely mapped brain areas.
Device implantation: The stimulator (“battery”) is placed under the chest skin and connected via wire to the electrodes.
Programming: The stimulation device is programmed after surgery; fine-tuning may take several months.
The entire operation takes about 6-8 hours on average. Hospitalization usually lasts 3-7 days. The battery typically lasts 5-7 years and must be replaced when depleted.
Risks and Side Effects
Like any medical procedure, DBS carries risks. The most notable include:
Brain hemorrhage (2-4%): Serious, but rare.
Infection (3-5%): Infection may develop at the device site, sometimes requiring device removal.
Electrode displacement, technical failures
Temporary speech problems, balance issues: Due to intense stimulation or regional effects
Mood changes (depression, mania, etc.): Especially in those with sensitive psychiatric backgrounds
Quality of Life and Hope: Personal Experiences and Perspective
DBS does not “restore” a Parkinson’s patient’s life to what it once was, but often opens a window to regained freedom. Returning to Mrs. Ayşe’s story: When her severe tremor subsided and she was able to peacefully hold her first grandchild, her eyes sparkled. “I found myself again,” she says.
According to accounts from many DBS patients, psychosocial benefits such as re-engagement with social life, increased independence, and improved mood are commonly reported. However, patients and their families must understand that DBS is not a “miracle,” but rather a “shared journey.” As the disease advances, new challenges can emerge, and it can take time to adapt to the changes brought by the device.
“The meaning of a smile after DBS may ease the struggle of years; hope grows firmer when paired with knowledge.”
Frequently Asked Questions & Answers
Does DBS cure Parkinson’s completely?
No. It does not eliminate the disease, but is particularly effective at controlling motor symptoms.Is it available in every center?
The best results are achieved at major centers with experienced, multidisciplinary teams.Is battery replacement difficult?
No, it is usually a minor day-case surgical procedure.Is lifelong follow-up required?
Yes. Regular doctor visits for device programming, medication adjustments, and symptom monitoring are essential.Does medication stop completely after DBS?
It is usually reduced, but rarely discontinued completely.
Practical Advice for Patients and Caregivers
If you are considering DBS, contact centers that perform the procedure and talk to patients who have already undergone the surgery.
Psychological preparation and social support are essential. Keep expectations realistic.
It is helpful for caregivers to access support groups where they can share feelings and ease the burden of care (Parkinson Foundation Support Resources).
Don’t neglect physical rehabilitation and gentle exercise.
Final Words: Hope, Knowledge, and Decision
Parkinson’s disease is not just an illness; it is a journey for both the patient and their family. Some days are filled with grief over limitations and loss. Sometimes, however, a treatment option—like DBS—can empower this journey with new hope and strength.
Informed decisions, open communication with trusted healthcare professionals, and a strong social support network can help you get the most from what DBS offers. Remember: hope may be hidden in a surgical decision or simply in a beautiful afternoon spent together.
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