Holding Steady

Deep brain stimulation can alleviate ‘the shakes’ in patients with Parkinson’s disease and essential tremor.

For people with tremor, drinking a glass of water is a challenge. A consequence of Parkinson’s disease or a disorder called essential tremor, it can make their hands shake so erratically, the glass never reaches their lips. For these patients, deep brain stimulation (DBS) can be the calm in the middle of a neurological storm.

Candidates chosen carefully

DBS involves interrupting abnormal nerve signals that cause tremor with electrical stimulation delivered to targeted areas of the brain. It’s a surgical solution reserved for patients who have been treated with medication that has lost its effectiveness or begun to cause other, unwanted side effects. A team comprising neurologists and neurologic surgeons together decide whether a person is a candidate for the procedure.

Pritha Ghoush“There is a lengthy screening process that includes evaluation on and off medication as well as neuropsychological testing to determine a person’s cognition and emotional state,” says Pritha Ghosh, MD, Co-director of the Movement Disorder Program and Clinical Assistant Professor of Neurology. “We do not want to send someone into surgery with an underlying condition such as depression.”

Deep Brain StimulationA two-part process

Donald ShieldsDBS begins with a computer-generated 3-D reconstruction of the patient’s brain so that the team can identify the entry point, end point and trajectory of the electrodes that will go into and through the brain. The patient’s head is fitted with a stereotactic frame, which accurately marks the sites, “since we can’t physically see the target,” says Donald Shields, MD, PhD, MBA, FAANS, Assistant Professor of Neurology.

The electrodes are inserted through two holes in the skull and descended slowly through the brain. Once positioned, they exit the head under the scalp, behind the ears and a small, battery-powered pulse generator is implanted in the chest.

Period of adjustment

After surgery, the brain is allowed to heal for two to three weeks, without the stimulator turned on. The patient is monitored and the settings on the stimulator are calibrated in progressive sessions.

“It can take a month to optimize the settings on each person,” says Dr. Shields. He notes that precision while positioning the electrodes and adjusting the stimulator after surgery are vital. “Many patients are referred to us at GW Hospital,” he says. “And of course, the more procedures you do, the better the results.”

Dr. Ghosh adds it all starts with an experienced team, able to choose patients who may respond well. “When DBS works, it works wonders,” she says.

Relief from down deep

Because of the success deep brain stimulation has had with disorders such as tremor, the procedure is being studied for epilepsy, cluster headaches, Tourette’s syndrome, chronic pain and depression. The use of DBS to treat epilepsy is showing promise through information derived from uncontrolled studies. These studies are guiding the development of more definitive efforts. Research on DBS in humans with epilepsy that has targeted the centromedian nucleus of the thalamus, the anterior nucleus of the thalamus and the subthalamic nucleus has shown that some patients seem to have a reduction in the severity or frequency of their seizures.

Source: National Institutes of Health; epilepsy.com/Epilepsy Foundation

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