Deep brain stimulation (DBS) is increasingly being used to treat Parkinson's and other movement disorders. This treatment method involves implanting electrodes into deep brain structures that are connected to a power device. The device is similar to a pacemaker and is implanted in the chest. It can be controlled and adjusted remotely by both doctors and patients.

The stimulation parameters are controlled by a computer to adjust amplitudes, frequencies and pulse widths. Common targets for DBS in Parkinson's disease include the subthalamic nucleus, the internal globus pallidus, and the ventral intermediate nucleus of the thalamus.

Current research shows promising results for DBS in the early stages of Parkinson's disease. A five-year study found that patients who received DBS in the early stages required lower doses of medication and showed long-term motor benefits over standard therapy. This study suggests that early DBS may reduce the need for complex Parkinson's medications.

Advances in DBS technology have resulted in increased programming flexibility, potentially improving therapeutic benefits.

New developments, such as pioneering DBS electrodes, help avoid current spread to structures that could cause side effects. Controlling the current to individual contacts on a DBS electrode allows the electric field between multiple active contacts to be shaped. These advances make DBS an effective treatment option.

More and more experts in the field have recently highlighted the latest developments in DBS technology and emphasized its growing importance in the treatment of Parkinson's disease. Research is also focused on using DBS to improve balance, gait and postural instability in Parkinson's patients, demonstrating the ever-evolving scope of DBS.

The surgical procedure itself includes several key steps:

1. Preoperative assessment and planning: Before surgery, patients are carefully selected because not everyone with Parkinson's is suitable for DBS. Criteria include, but are not limited to, response to levodopa, type of Parkinson's symptoms, and absence of certain cognitive or psychiatric problems. Imaging techniques such as MRI are used to identify the exact target region in the brain.
2. Implantation of the electrodes: Small holes are drilled into the skull under local or general anesthesia. Electrodes are then inserted into the brain, typically into the subthalamic nucleus or internal globus pallidus, depending on the specific symptoms and goals of treatment. Placement of electrodes is often refined through intraoperative testing and neurophysiological monitoring to ensure they are positioned correctly.
3. Implantation of the pulse generator: In a separate step, often on the same day or later, a pulse generator, similar to a pacemaker, is implanted under the skin, usually in the chest area or sometimes in the lower abdomen. This device generates the electrical impulses that are sent to the brain electrodes.
4. Connection of components: The electrodes in the brain are connected to the pulse generator by wires running under the skin.
5. Programming and setting of the device: After surgery, the device is programmed and fine-tuned to achieve the best results. This usually occurs a few weeks after surgery when the patient has recovered from the procedure. Settings can be adjusted later to account for changes in symptoms or side effects.
6. Aftercare and adjustments: Regular follow-up is required to optimize device settings and ensure the patient is responding well to treatment. If necessary, medications can be adjusted.

This surgical procedure is complex and requires a multidisciplinary team of neurosurgeons, neurologists, specialized nurses and sometimes neuropsychologists. DBS does not provide a cure for Parkinson's, but is a way to manage and relieve symptoms, especially when medications are no longer sufficiently effective.

Munich, November 14.11.2023th, XNUMX, Jürgen Zender