For people who suffer from movement disorders like tremor and Parkinson’s, medication is typically the cornerstone of treatment. Medications, however, don’t work forever. When they fail, or when their side effects become problematic, a minimally invasive surgical approach—deep brain stimulation (DBS)—is bringing relief to people with movement disorders, psychiatric disorders, seizures and certain types of chronic pain.
DBS is helping many people regain the sense of control and predictability they lost with their disease. Typically, people with Parkinson’s disease who undergo DBS surgery at Stanford have a 60 to 90 percent improvement in their symptoms and a 60 to 100 percent reduction in medication use. The procedure is most effective for people who have responded well to medication, but whose ability to live their lives normally has been severely hampered by medication side effects.
“The success of treatment outcomes at Stanford relies on the expertise and experience of our movement disorders neurologists who program DBS devices and adjust medication accordingly,” said Dr. Helen Bronte-Stewart, chief of Stanford Movement Disorder programs.
To implant a DBS device, surgeons place an MRIguided wire into a targeted brain structure. At the tip of that wire are four small electrodes that release electrical impulses to block tremor. The wires are connected to a two-inch by three-inch battery pack. That pack sits under the skin in the chest, just as cardiac pacemakers do. The surgery is done in the awake state, so surgeon and patient can see the effects of the procedure in real time.
Stanford’s Stereotactic and Functional Neurosurgery Program, directed by Jaimie Henderson, MD, is leading the program’s expansion of DBS application. One of its members, Casey Halpern, MD, assistant professor of neurosurgery, has already been successful in treating patients with obsessivecompulsive disorders (OCD) with a standard DBS device.
“If a millimeter-sized electrode can have such an incredible effect on a medical condition like tremor and Parkinson’s Disease,” Halpern said, “why couldn’t it do something so much different, but something just as effective, in a different part of the brain for a different brain-related medical condition?” With that idea in mind, Halpern has turned his research to applying three kinds of brain stimulation devices to obesity, binge eating disorder and addiction.
“While frightened of the prospect of brain surgery at first, most patients come to find their experience transformative,” said Halpern. “They feel like they’re able to be a team member in their own medical care.”
“In a non-lesional, nondestructive way, DBS is able to transform these patient’s lives into what many would say is almost feeling completely normal,” said Halpern. “To be able to have that kind of effect on patients has been what inspires me every day to continue with this kind of specialty.”