Transcription:
When is Deep Brain Stimulation the Right Treatment Option for Me?

Melanie Cole, MS (Host): If you suffer from Parkinson’s disease and you’ve not seen positive effects from medication, a procedure called deep brain stimulation might be right for you. My guest today is Dr. Cindy Zadikoff. She’s a neurologist and movement disorder specialist at Northwestern Medicine. Dr. Zadikoff, tell us a little bit about Parkinson’s disease and what are some the effects of living with Parkinson’s?

Cindy Zadikoff, MD (Guest): So, Parkinson’s disease is a neurodegenerative condition which effects a neurotransmitter called dopamine in the brain. For reasons that are not entirely clear, when our brain stops making dopamine, we can develop multiple different symptoms. The most notable ones that people are aware of are people can develop slowness of their movements, especially doing things that require fine coordination like brushing teeth, cutting up food, doing up buttons. Their walking may become more shuffled and slow, which could lead to falls. They can also develop a tremor, which is probably the thing that people most often associate with Parkinson’s disease.

Melanie: If somebody does have the tremor, what typically, because Parkinson’s is not curable. You’re just working on real symptom management. What typically had been used for essential tremor?

Dr. Zadikoff: For essential tremor, we used multiple different medications to try and treat the tremor. In some patients, that can be very, very effective. But if the medication isn’t effective, that’s when we think about deep brain stimulation.

Melanie: Then tell us a little bit about what that is. Is it a new treatment? Is it dangerous? Tell us a little bit about it.

Dr. Zadikoff: So, Parkinson’s disease and essential tremor have both been treated by deep brain stimulation for many years now. So, this is actually not a new treatment at all. We’ve been doing this for over 30 years now. So, this is really just one step in the treatment algorithm of treating these conditions.

Melanie: So how long does the treatment last? Tell us a little bit about what’s involved and what are the advantages of it?

Dr. Zadikoff: So, what happens is once we determine if a person is an appropriate candidate for deep brain stimulation, what happens is that they go into the operating room with the surgeon. The surgeon actually makes a very small hole, about the size of a five-cent piece on either side of the brain, kind of in the region of the widow’s peak in the head. Then we put an electrode deep into the brain, that’s why it is called deep brain stimulation for no other fancy reason than that. The person is actually awake during the procedure. Because during the procedure, we are actually listening to the sounds of the cell. We are asking the person to do things. We’re stimulating to make sure we’re in the right area. That electrode is connected to a pacemaker that goes right into the check. So, people who have pacemakers for the heart, it’s the same idea as that. With that, we are sending signals to the brain. These signals to the brain can then ultimately help turn the signals that the brains are making into more physiologic signals more natural signals like before they had the disease to allow us to alleviate the symptoms of their condition.

Melanie: As this is a treatment for essential treatment as well as tremor and involuntary movements that are associated with Parkinson’s disease, doctor you mentioned if someone is a good candidate. Who is a good candidate for this procedure?

Dr. Zadikoff: So, it depends on the condition that we are talking about. So, for essential tremor, typically these are patients whose medicines don’t work for them and they're still really bothered by their tremors. And their tremors really are interfering with their ability to do their activities of daily living because it makes it hard for them to pour water or eat or write or things like that. So even if medications don’t work and especially if medications don’t work, then we do the surgery, the deep brain stimulation.

In Parkinson’s disease, it’s a little bit different. So, in Parkinson’s disease, we mainly use a medication called carbidopa/levodopa. People actually have to respond to that medication in order to get a benefit from surgery. So, surgery doesn’t do more than what the medication’s do, with one caveat which I’ll get to in one second. The problem with the medications over time in Parkinson’s disease is that you have what’s called wearing off. So, the medications only last a short while and people need to take their medications multiple times throughout the day to be able to function properly. It’s hard to do that. When they take those medicines, they can get the extra movements that we refer to as dyskinesias. So, when people respond to the medications but are having fluctuations and dyskinesias so they're on a roller coaster throughout the day, that’s when we think about the surgery for Parkinson’s disease.

The one caveat that I was going to mention was that sometimes the tremor in Parkinson’s disease doesn’t respond to medication. Even in that situation, we still can do deep brain stimulation because we still can treat the tremor even if it doesn’t respond in Parkinson’s disease.

Melanie: What is life like post procedure for the patient, doctor? Is this something that is now implanted for the rest of their life? Tell us a little bit about their life after.

Dr. Zadikoff: Yeah, great question. So ideally, their life after is what they want their life to be. That is our goal of treatment really is to get people to be allowed to go back to doing the things that they wanted to do. Be it because they had essential tremor or Parkinson’s disease, they weren’t able to do those things because their symptoms got in their way. So, the hope is that with deep brain stimulation, we can treat their tremor in Parkinson’s disease and essential tremor. We can treat their slowness, we can give them more predictability of the day in Parkinson’s disease, so they don’t fluctuate throughout the day. So, again, they can go back to living with the disease and not spending their whole day managing the disease. So, it does remain implanted for life. And for multiple of these symptoms, it does continue to work throughout their lives.

We are, unfortunately, not curing these conditions. We still don’t yet have cures for these conditions, but with these options, we can help manage their symptoms and give them a good quality of life for many years to come.

Melanie: Just as people have questions about pacemakers and the like, does batter life play a role in this? What is the actual device like?

Dr. Zadikoff: Yeah. So, we have different options that are available to us now in terms of batteries and the electrodes. Things that allow us to do a little bit more sophisticated programming if we need to. I always tell patients it’s like an insurance policy. I really want to go with a simple approach first. But with some of these more sophisticated things that are available now, if the simple approach isn’t working, I now have the option to do a little bit more of a sophisticated approach that will hopefully give people, again, the best outcomes possible. So most of the batteries are still not rechargeable, but there are some batteries that are rechargeable as well depending on the condition that we’re treating. And I always say how much juice we’re using. So how much energy we’re using in the batteries to control the symptoms in the brain. That will determine how long a battery will last if it is not the rechargeable version. So that can be anywhere from about three years to up to about 10 years, again, just depending on the situation.

The nice thing is that if we do need to change the batteries out, which, again, for many people we do, that is a very simple procedure. Once they’ve gone through the hard procedure of having these electrodes implanted in the brain, the rest of it I don’t want to say is a cakewalk cause it’s still a surgery, but it really is an outpatient procedure that just involves replacing the battery in the chest. The patients doesn’t have to have anything done to their head again.

Melanie: Isn’t that amazing what medical science can do these days? Wrap it up for us Dr. Zadikoff with your best information and advice when people have a loved one that is suffering from Parkinson’s of another condition that would cause essential tremor and they're looking at deep brain stimulation. What questions would you like them to ask their physician in terms of the physician’s experience and life after the procedure and your best advice?

Dr. Zadikoff: I think most important a patient has to advocate for themselves. Really finding out is there anything else? I would hope that physicians would know that there was something else, but I do think it’s important for patients to advocate for themselves, which means educating themselves. There’s so much good information available still. The internet is the best and the worst. So, you have to go to reputable sites, like national sites, national organizations, to get information. Is there anything else that can offer me?

Then finding out if you're an appropriate candidate is going down to one of the centers, like a center like ours, where we specialize in these things so that the patient can get the best information. Maybe it turns out that they're not a great candidate, but you’d rather know that than find out that you’ve missed an opportunity to get a treatment that might actually be useful for you.

Melanie: Thank you so much for joining us today and for explaining this so very well. And sharing your expertise about deep brain stimulation. Thanks again. You're listening to Northwestern Medicine Podtalk. For more information on the latest advances in medicine, please visit nm.org. That’s nm.org. This is Melanie Cole, thanks so much for listening.