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Physicians Update

 
Fall 2013

Deep-Brain-Stimulation Surgery Eases Symptoms for Patients with Some Movement Disorders

Dr. Pouratian performs Deep Brain Stimulation surgery Deep-brain stimulation (DBS) — the implantation of a “brain pacemaker” and electrodes to ease symptoms of movement disorders — is a safe and effective procedure that could bring symptomatic relief to many patients who are currently experiencing a severely impaired quality of life, says Nader Pouratian, MD, director of UCLA’s Neurosurgical Movement Disorders Program.

“This is a technology that’s extremely underutilized,” says Dr. Pouratian. “When you consider the number of patients with movement disorders who aren’t benefiting from medication, it has the potential to help many more people.”

DBS functions like a heart pacemaker, except that instead of going to the heart, the electrodes are strategically placed in the brain. The pacemaker includes a chest-implanted generator that sends continuous pulses. Just as the heart pacemaker helps to correct an abnormal heart rhythm, the brain pacemaker uses these pulses to correct the abnormal patterns of activity in the brain for patients with neurological disease — easing the involuntary movements characteristic of such conditions as Parkinson’s disease and essential tremor.

DBS is most commonly performed as an asleep/awake/asleep procedure: The patient is asleep and anesthetized at the beginning of the surgery, as a hole is being drilled in the skull; once the potentially uncomfortable phase is over and the brain is exposed, the patient is awakened and asked to respond to verbal commands, providing feedback to assist the surgical team in optimal placement of the electrodes before being put to sleep again as the skull is closed up. Since there are no pain receptors within the brain, patients experience no discomfort while awake during the operation.

Deep Brain Stimulation surgery at UCLA “This is a surgery whose goal is to improve function and quality of life,” explains Dr. Pouratian. “The best way to ensure that we are achieving that goal is to actually test the patient during surgery, when we first put the electrode in, and make sure we’re getting the benefits from the stimulation while limiting the side effects. If it’s not in the optimal position, that’s our opportunity to move the electrode.”

First approved by the U.S. Food and Drug Administration (FDA) in the late 1990s, DBS carries relatively minimal risk and, in most cases, it significantly improves patients’ quality of life. “This doesn’t change the underlying disease,” Dr. Pouratian says. “It doesn’t change the time course or the progression; it’s a purely symptomatic treatment.”

Since DBS was initially performed approximately 20 years ago, some 100,000 people have been implanted throughout the world. UCLA has performed more than 500 of the surgeries. While most often used for patients with Parkinson’s disease or essential tremor, it is also FDAapproved for a third movement disorder, dystonia (characterized by sustained involuntary muscle contractions), as well as for obsessive-compulsive disorder. It is currently being studied for its potential to help in a number of other conditions — including chronic pain, post-traumatic stress disorder, Alzheimer’s disease, Tourette’s syndrome and depression.

In the United States, an estimated 10-million people have essential tremor, and 1 million have Parkinson’s disease. Although a large number of these patients could benefit from DBS, many are unaware of the procedure, while some who do know about it are reluctant to undergo a brain operation, Dr. Pouratian says. He notes that medications are the first-line therapy for movement disorders, and they can be effective in many patients. But patients who either don’t receive satisfactory benefit from their drugs, experience complications that can’t be managed, or have intolerable side effects should be evaluated to determine whether DBS is an option. At UCLA, patients are seen by a multidisciplinary team, led by a neurosurgeon and by neurologist Yvette Bordelon, MD, PhD, who help to determine the best course of action.

Deep Brain Stimulation surgery at UCLA “We are fortunate in our field to have very good studies — randomized controlled trials — that show DBS to be an excellent therapy,” says Dr. Pouratian. “There is significant improvement in quality of life with the surgery, well beyond what patients get from the available medications. It’s not a cure, but it’s quite clear that they spend much more of their day in a better condition — able to participate in many more activities and to enjoy their lives more. One of the most powerful comments I hear from many patients is that they wish they had done it earlier.”

For more information about UCLA’s Deep-Brain-Stimulation Program, go to: dbs.ucla.edu





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