It is important that your medical provider be aware that you have DBS since there are some procedures that can not be performed if you have DBS. Examples of procedures that are not safe to be performed with DBS are body MRI, certain types of cautery and diathermy (a form of ultrasound used in specific situations to speed tissue healing.) It is recommended that your doctor call Medtronic Inc. (current DBS manufacturer) clinician support services (800) 707-0933 before any procedure to review if there are any concerns or interactions with your device.
One way to alert clinicians that you have DBS in an emergency situation is to wear a medic alert bracelet. This bracelet can be inscribed with important information such as allergies and a statement that you have DBS. You can include the emergency clinician support phone number and warnings such as “MRI and diathermy contraindicated.”
Mammograms are often a concern because they are done close to the battery site. Mammograms can be performed as long as the technician avoids compression of the battery which is usually located just below the clavicle in the chest. It is important not to compress the battery or extension wires. Breast MRI can not be performed. Diagnostic ultrasound of suspicious breast lesions can usually be performed if needed; but once again the ultrasound probe should not be used over or directly adjacent to the battery. Your technician should call the Medtronic customer support number listed above for more specific guidance.
Researchers at the University of Virginia are conducting a research study to investigate a new way of controlling tremor. The research study is designed to investigate the safety and feasibility of ultrasound waves targeted at the thalamus, a brain region important for tremor control. Similar to the thalamotomy of the past, this technique causes a lesion or destruction of brain cells that affect tremor.
Unlike traditional thalamotomy, this technique does not require brain surgery that includes drilling a hole in the skull to gain access to the brain and damage the cells but instead relies on MR guidance of these focused wave forms to precisely reach their target. In some ways it is similar to gamma knife thalamotomy, a technique that is sometimes used to treat tremor through focused gamma waves that when converging on a brain region can damage tissue (gamma knife is a common radiosurgery technique used for treating brain tumors and a condition called trigeminal neuralgia). These new techniques are promising and offer a less invasive approach to tremor control. It is important to note that research is just beginning and this current study is being conducted to investigate safety. If proven safe, larger studies will need to be done to test the benefit. Other considerations for this experimental procedure include
- Lesioning techniques (damaged cells) are not reversible since tissue is destroyed. If the wrong area of brain tissue is damaged it can not be restored.
- Focused ultrasound and gamma knife surgery does not have the same risk and recovery period associated with traditional neurosurgery offering a potential treatment for people in which standard surgery carries too much risk.
- Only unilateral thalamotomy at present is recommended for tremor on one side of the body due to concern of side effects with bilateral thalamotomy such as speech and walking problems.
- Research is for tremor predominant Parkinson’s disease, a condition in which other non-tremor movement symptoms are minimal compared with tremor. Non-tremor symptoms of Parkinson’s such as rigidity and bradykinesia are not treated with thalamotomy.
- There is limited experience about the combined effect of thalamotomy and other surgical techniques such as deep brain stimulation (DBS) if this were to be needed in the future.
- Like gamma knife thalamotomy, cells that are to be destroyed are located with MR imaging. Unlike thalamic DBS where a brain electrode is used to locate this precise area in the operating room by recording and stimulating actual brain cells involved in tremor, there is no ability to record the neuronal activity to further ensure that the area of tissue destruction is accurate for the individual.
Given these issues, researchers at the U of VA have designed a careful sham (placebo) controlled study to help effectively address these concerns. These new techniques show promise and offer hope for additional therapies in the future.
DBS treats movement symptoms of Parkinson’s specifically tremor, dystonia motor offs and dyskinesia. DBS does not typically improve speech and in some cases can be associated with worsening speech. The following information may help you understand the complex association between speech changes with Parkinson’s and DBS:
- DBS typically helps motor symptoms that also respond to medicine. Although difficult to predict, DBS may improve speech if levodopa also significantly improves speech. However, in most cases, speech is not helped by medicines suggesting DBS will also not help.
- If speech is still responsive to levodopa, under-medication can also worsen speech. Medicines are often reduced after surgery.
- Subthalamic (STN) DBS surgery can affect ‘verbal fluency’. This can be noticed as a difficulty ‘finding or getting the right word out’.
- DBS programming can worsen speech as a noted side effect to over-stimulation. This is probably the most common cause of significant speech change after surgery.
- Speech can worsen as Parkinson’s progresses over time even with DBS. This is usually a gradual decline.
- Immediate change in speech after surgery can occur as a result of brain bleeding or other problem during surgery. This can improve over time.
- A speech therapist can help you understand the potential impact of DBS on speech and help improve communication at any stage of your disease.
This information serves as a guide only. Only your healthcare provider can answer the questions about how DBS will impact speech for you.