Is DBS Right for Me?

This page covers when to consider DBS, how we evaluate patients for surgery, and the improvement you can expect for Parkinson's disease, dystonia, and essential tremor.

When is the right time for DBS?

The answer is often simpler than people expect. The right time for DBS is when quality of life is deteriorating despite adequate medication management. The following signs indicate that the timing may be right:

Medications are not working as well.
Medications are wearing off much faster.
Side effects are limiting the medication that can be used.
Botox is not working, not possible, or too burdensome.
Dyskinesias occur when taking medication (Parkinson's disease).
The person is withdrawing socially because symptoms are difficult to control.
Any important aspect of quality of life has declined significantly.

The right time for DBS often is obvious.

The right time for DBS often is obvious. (Gary Larson, The Far Side)

The DBS evaluation process.

Evaluation for DBS surgery is a multidisciplinary process. Neurologists, psychiatrists, neurosurgeons, neuropsychologists, and other staff work together on a team dedicated to considering the whole patient. Evaluation and scheduling for DBS surgery can take 3 to 12 months, depending on provider and facility availability.

Initial clinic visits.

Movement disorders neurologist, for Parkinson's disease, dystonia, or essential tremor. This visit includes OFF-ON medication testing with the Unified Parkinson's Disease Rating Scale (UPDRS), a tremor rating scale (TRS) for essential tremor, or the Burke-Fahn-Marsden (BFM) dystonia rating scale.
Psychiatrist, for obsessive-compulsive disorder. This visit includes the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
Neurosurgeon.
Neuropsychologist.
Speech evaluation at Mass Eye and Ear.

Additional studies.

MRI. Special sequences are required for surgical planning.

Expected outcomes.

Parkinson's disease.

4 more hours of "ON" time each day, on average.
Fewer motor fluctuations.
40 to 70% improvement in tremor, slowness, and stiffness. Your best "on-medication" state is the best predictor of how much your motor symptoms will improve.

Dystonia.

40 to 60% improvement, on average.
Patients with DYT1 mutations can experience 90% improvement.

Essential tremor.

50 to 90% improvement.
Axial symptoms such as head and voice tremor should improve, although typically not as much as hand tremor.