By Danette Taylor, MD
Henry Ford Hospital, West Bloomfield, Michigan
Most neurologists have had the opportunity to witness the almost-miraculous results that carbidopa/levodopa can bring to a patient with untreated Parkinson's disease (PD). Likewise, most neurologists have shared the frustration of the seemingly inevitable decline that patients experience when motor fluctuations set in, sometimes as soon as three years after treatment was started. For too long, there was nothing to do but adjust medications to an ever-closer dosing schedule, a system that many patients found difficult to follow and many neurologists found difficult to define adequately.
In the late 1990s, the use of deep brain stimulation (DBS) to treat some of the motor components of PD was introduced. DBS involves inserting a small electrode into an area of the brain responsible for certain movements. The electrode is connected to a small battery (or impulse generator) which is located in the chest wall. The device is very similar to pacemakers that some patients receive for irregular heart rhythms, except it stimulates the brain, rather than heart muscle. Since its introduction, almost 100,000 patients have undergone the procedure. We now have formal data to suggest that even after 10 years of therapy, substantial value is still identified.
As a neurologist in a movement disorder practice, I have several patients who have undergone DBS to treat their PD symptoms over the past eight years. Some are now on their second set of batteries. One gentleman, originally diagnosed with PD in 1994, opted for DBS surgery in 2004. Seventeen years after his diagnosis, he remains independent and recounts with relish his ability to dance at his daughter's wedding last summer. Another patient was able to participate in a half-marathon 12 years after his diagnosis of PD. He attributes a part of his success to the symptomatic control achieved from his DBS.
The recognition that DBS can provide many years of symptomatic relief should come as welcome news to all physicians who treat patients with Parkinson disease. This information additionally offers at least one answer to the question asked by so many patients: "What options will I have down the road?"