New Non Invasive DBS

There are now two brain procedures that are FDA approved for use in Parkinson’s: deep brain stimulation (DBS) and non invasive high intensity focused ultrasound (FUS). Deep Brain Stimulation has been successfully used more than 160,000 times to treat people with movement disorders (Parkinson’s, essential tremors. dystonia), neurodegenerative disease (Alzheimer’s), neurological disorders (epilepsy), and increasingly for psychiatric disorders (depression, Tourette’s disease). DBS works by delivering constant electrical stimulation to problem areas of the brain similar in concept to a pacemaker for the heart. It involves implanting electrodes deep within the brain. The amount of stimulation delivered by the electrode is controlled by a pacemaker-like device placed under the skin in the chest. DBS is a physical operation that drills holes in you head and inserts electrodes into target areas deep within the brain as a first step. This part of the procedure is done with the patient conscious so they can answer questions and respond to instructions by the surgeon. The second part of the procedure involves inserting a neurotransmitter, usually just below the collarbone, that sends electrical pulses to the electrodes through wires running from the brain under the skin of the head, neck, and shoulders to the transmitter.

I’ve had Parkinson’s  for eight years and would like the benefits of DBS but am afraid of the operation. Drill holes in my head, stick electrodes in my brain, insert a battery pack transmitter in my chest, and run wires inside my body - you have to be kidding, definitely not for me, too scary. I know it’s helped a lot of people but no thank you. I pass on DBS. That is until now because in 2018 the FDA approved a new non invasive DBS for use with PD tremors and PD related dyskinesia that does not benefit from medicine.

Focused ultrasound is a non-invasive surgical procedure that uses ultrasound waves to destroy brain cells in the basal ganglia that cause movement problems. FUS is FDA approved to treat Parkinson’s tremors and is in clinical trials for dyskinesia (uncontrolled, involuntary movements that can develop with long-term use of levodopa). MRI brain imaging is used to precisely guide and direct high intensity focused ultrasound waves to destroy target cells deep in the brain that cause movement problems without harming non target tissue.

Focused ultrasound is a one step procedure that is non invasive and does not require putting electrodes in the brain, batteries that need replacing or recharging in the chest, or wires that connect them and does not need doctor office visits for programming. It uses MRI imaging to guide ultrasound beams to destroy brain cells that cause tremor without requiring anesthesia. Ultrasound is not reversible because it destroys brain cells. The problem with focused ultrasound is that it can now be performed on only one side off the brain meaning it eases symptoms on only one side of the body. When done on both sides it caused problems with speech, swallowing, and cognition. Unlike DBS, FUS does not require any maintenance. There are no wires, electrodes, or batteries, and it does not need repeated doctor visits for programming. FUS is new. We do not know the long term effects. DBS has been around for twenty years and is well tested and known. It usually benefits PWP for about ten years.

Both DBS and FUS help alleviate symptoms. What we really need is a cure.