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Caring for a patient with Parkinson's disease is not an easy task. They can experience severe fluctuations in their symptoms. For some Parkinson disease patients, you can help improve their symptoms and quality of life with a procedure called deep brain stimulation.
My experience as Neurosurgeon has allowed me to share some of my knowledge about this procedure. This article covers:
Deep brain stimulation is a surgery that involves implanting a stimulator device that can send electrical signals to the brain to affect the cells that trigger your body movements . This surgery helps to treat a number of movement and psychiatric disorders such as :
Patients who go through deep brain stimulation are generally satisfied with the result and would recommend other patients to undergo the same procedure . However, the success rate is highly dependent on the patients’ characteristics and the stage of their disease.
A patient with Parkinson's disease may be a suitable candidate for deep brain stimulation if :
If a patient does not fit the above checklist, it does not necessarily mean that he or she is not suitable for DBS. Some of the conditions may be optimised prior to surgery.
Some of the benefits of deep brain stimulation are: 
Other points to take note:
Deep brain stimulation is typically performed as a two-stage procedure.
In the first stage:
In the second stage:
In some cases, the procedure is performed in one stage. Which means the electrodes and battery are implanted in the same session. You should discuss with your neurosurgeon to see which arrangement is best suited for you.
You will feel when the battery is running low as the symptoms start to reappear. However, the battery power is checked at every clinic visit and can also be checked by the patient. This usually gives ample notice that the battery is starting to run out.
The battery change involves a simple surgical procedure at the chest area only.
Usually, the recovery time for deep brain stimulation varies from 2-3 weeks. During the recovery time, you have to keep an eye on complications that might occur, particularly wound infection .
Infection can occur if the wound is not taken care of properly. Tips on reducing the risks of infection include:
In the event of infection, the doctor will prescribe a course of antibiotics. If the infection is unable to be resolved with antibiotics, the DBS system may have to be removed. Hence, I cannot emphasize enough the importance of proper wound care after surgery.
In some cases, patients can experience certain mood changes like low mood or elevated mood after the surgery. Both of these can happen. Therefore, you need to keep an eye on the changes.
Some of the signs of low mood which the patient may exhibit include:
If these symptoms continue, tell the doctor immediately.
There are generally no lifestyle modifications required in the immediate period after surgery beyond monitoring for surgery-related complications.
The need for levodopa medications is usually reduced but rarely eliminated, after DBS. Reduction in the dosage of levodopa or other medications is facilitated by the continuous stimulation from the battery. This stimulation tricks the brain into thinking it is receiving a higher dosage of dopamine . The extent of levodopa reduction after DBS will be advised by the neurologist or neurosurgeon.
There are 3 components of the implanted deep brain stimulation device: 
The lead is a thin wire that typically has 4 contacts attached to it. The electrodes are small tip-shaped devices that are implanted into the brain. The placement of the electrodes is dependent on the patient’s condition.
The neurostimulator uses a battery to produce electrical signals that are transmitted to the brain via the lead extension and electrodes. The neurostimulator is placed near the collarbone and is hidden underneath the patient’s skin.
The battery in the neurostimulator usually lasts three to five years. The procedure to replace the battery is usually done under general anaesthesia.
The extension is an insulated wire under the skin that connects the lead to the neurostimulator.
Deep brain stimulation becomes the best option if the patient’s symptoms are insufficiently well controlled by medication. This usually happens several years after the diagnosis. Deep brain stimulation also reduces the patient’s need for levodopa and fluctuations during the ‘on’ and ‘off’ period. 
The ‘on’ period is when the levodopa works optimally to improve the patient’s symptoms, and the ‘off’ period is when the drug does not improve the symptoms as well as it can. Such symptoms include motor symptoms (tremor and stiffness) and non-motor symptoms (anxiety) .
When symptoms are not well controlled, the patient experiences an increasing longer duration of ‘off’ periods.
When the battery depletes, a replacement will be required to continue enjoying the benefits of deep brain stimulation. Battery change involves a simple surgical procedure at the chest area only under general anaesthesia.
Deep brain stimulation is not a cure and does not stop the disease from progressing. As the disease progresses, symptoms will get worse and stimulation parameters will need to be adjusted to manage the symptoms as necessary.
Deep brain stimulation surgery is a claimable procedure by insurance and Medisave. Check with your insurance company to find out if coverage applies.
Coverage by Singapore Ministry of Health with Medisave can be categorised as :
Even though deep brain stimulation is considered expensive, it is effective in saving money in the long run. Deep brain stimulation is also generally safe to use to improve the motor symptoms of Parkinson’s disease and reduce the need to take levodopa.
Make sure that the patient that you are caring for is suitable for this procedure to minimise the risk of complications that might occur. Do consult a trusted doctor if you have more questions regarding deep brain stimulation.
After completing medical school, Dr Kon continued his medical training in neurosurgery and neurocritical care at various institutes in the UK which include the National Hospital for Neurology and Neurosurgery (London), Charing Cross Hospital (London), Addenbrooke’s Hospital (Cambridge) as well as the National Neuroscience Institute (NNI) in Singapore. He obtained his PhD at Imperial College London and subsequently completed his fellowship at Toronto Western Hospital, the University of Toronto in Canada.
You can find Dr Kon at NeuroAsiaCare
This is again a very common question for people who are considering DBS, and if you are selected, we pick the participants very carefully. Usually, we achieve a very high success rate, meaning that they feel it is a very great help to them and they will even recommend it to their friends with Parkinson's disease. I think in terms of failure, taking in mind the complications we expect, there is a risk of serious complication about 1% and a risk of infection about 3%.
Part of the care is the kind of protocol people use to treat Parkinson's Disease. I think some doctors might not be too familiar with DBS as a treatment, therefore if you are not too familiar with DBS, it is much harder to offer. Sometimes there are misconceptions on the risk. Some people think it's extremely risky, but I think it really depends on your surgeons. If your surgeon has done a lot of this procedure and does it routinely, I would say it is a relatively safe procedure.
Ended on June 19, 2020
After completing medical school, Dr Nicolas Kon continued his medical training in neurosurgery and neurocritical care at various institutes in the UK which include the National Hospital for Neurology and Neurosurgery (London), Charing Cross Hospital (London), Addenbrooke’s Hospital (Cambridge) as well as the National Neuroscience Institute (NNI) in Singapore. He obtained his PhD at Imperial College London and subsequently completed his fellowship at Toronto Western Hospital, University of Toronto in Canada. Before practising at Mount Elizabeth Hospital. Currently, he is an Adj Associate Professor at the Yong Loo Lin School of Medicine, NUS. He is actively involved in several clinical and translational research and multi-centre international trials. In addition, he holds several patents for his discoveries. He has authored more than 80 peer-reviewed publications and serves on the Centralised Institutional Review Board. Dr Kon is the first neurosurgeon to use the Brainpath minimally invasive neurosurgical technique in Asia. He has a longstanding commitment to neurosurgery and has received a long service award from the National Neuroscience Institute, Singapore for his contribution. In addition, Dr Kon also has a strong passion towards patient care and has been awarded several Service with A Heart awards by the SGH.