This is a natural reaction to thinking about surgical treatment. Unlike operations for cancer or heart disease however, DBS is an entirely elective procedure and the decision to proceed to surgery is a choice that patients make after carefully weighing up alternatives.
Patients who are interested in pursuing surgery undergo a careful evaluation process which includes Brain MRI, Neurologic assessment by Dr Silberstein, Psychiatric review with Dr Meagher and Neurosurgical consultation with Dr Cook. These clinical reviews allow a careful appraisal of the potential benefits and risks in each individual case. Most patients find this process very helpful in determining whether or not to proceed to DBS.
Almost all patients experience substantial improvement in symptom control by the time they leave hospital. Optimising stimulation and medications after surgery does take time however – usually around 6 months. These changes are managed by a network of Neurologists who have trained with Dr Silberstein and the Sydney DBS surgical team. Most patients require 3-4 outpatient Neurologic reviews in the first six months. Annual or bi-annual review is generally recommended thereafter.
The effects of DBS on personality, cognition (thinking) and behaviour have been extensively evaluated in many international studies. Transient or short lived psychologic changes are common in the first month or so after surgery as stimulation & medication are titrated, and patients adjust to their new circumstances. Long term changes in behaviour are very uncommon.
Most patients with Parkinson’s disease initially experience many years of good symptom control with tablet therapy. After 5-10 years of treatment however, many patients find that the benefits of tablet therapy become inconsistent and unreliable. Less predictable symptom control can sometimes be associated with excessive and involuntary movements termed dyskinesias. It is generally at this stage the next level of therapy termed ‘Advanced therapy’ or ‘Device assisted therapy’ is considered.
There are three forms of advanced therapy available for the management of PD:
Apomorphine: an injectable medication, which can be delivered intermittently or using an injection pump.
Duodopa: A gel formulation delivered directly into the intestine through a feeding tube inserted through the abdominal wall via the stomach.
DBS: A procedure where permanent stimulating electrodes are implanted in the brain and connected under the skin to a battery implanted in the chest or abdominal wall.
All three techniques can be effective in ironing out symptom control and reducing dyskinesia. Often, all three are reasonable options. The choice of therapy is made by the individual.
With comparison to apomorphine and Duo-dopa, DBS has the advantage that all components are implanted under the skin. This leads to considerably lower maintenance demands on patients and their carers, substantially reduced incidence of device related complications and much improved cosmetic outcomes.
DBS is associated with substantially improved symptom control for all of the conditions which it is used to treat.
Honest pre-operative discussions for expected outcomes and recovery after surgery aid in the transition to improved health. Meticulous surgical technique and long term follow up by dedicated DBS trained Neurologists helps patients achieve maximal benefit in the long term.
We implant both non-rechargeable and rechargeable batteries.
Non-rechargeable batteries generally need to be changed after ~ 3 years. Rechargeable batteries by contrast, last ~ 9 years but require charging in a seated position for 2-3 hours per week. Battery life can vary between individuals. All patients are encouraged to check their battery monthly to reduce the risk of unexpected battery failure.
A number of cost related options are available, which patients may elect depending on their individual circumstances. Cost is generally discussed early in the assessment process with Dr Silberstein. The cost of the surgery depends on a variety of factors including Private Health Insurance cover.
We proudly partner with Parkinson’s NSW and Shake It Up Foundation to ensure communities feel supported throughout their Parkinson’s journey. Every journey is unique to you and your family, both Parkinson’s NSW and Shake It Up are here to assist you. Throughout the year both Dr Cook and Dr Silberstein attend community events to give updates and answer any questions you may have about new research or treatments. We encourage you to sign up to receive up to date information from both charities about upcoming events, information, research breakthroughs, etc.
You can also follow Sydney DBS on Facebook to keep up to date with latest news and events.